Target values of cardiovascular risk factors are not associated with all-cause mortality in patients with type 2 diabetes mellitus

• Published in: PloS one Vol. 10; no. 4; p. e0124536
• Main Authors: Pacilli, Antonio, Lamacchia, Olga, Fontana, Andrea, Copetti, Massimiliano, Cignarelli, Mauro, Trischitta, Vincenzo, De Cosmo, Salvatore
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 30.04.2015; Public Library of Science (PLoS)
• Subjects: Aged; Antihypertensives; Blood cholesterol; Blood pressure; Blood Pressure - physiology; Body mass; Body mass index; Body size; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - mortality; Cholesterol; Cholesterol, LDL - blood; Diabetes mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - mortality; Female; Glomerular filtration rate; Glucose; Glycated Hemoglobin - metabolism; Health risks; Hemoglobin; Hemoglobins; Humans; Hypertension; Low density lipoprotein; Low density lipoproteins; Male; Middle Aged; Mortality; Patient outcomes; Patients; Risk analysis; Risk Factors; Sex; Smoking; Type 2 diabetes
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0124536

To investigate prospectively the relationship between target values of glycated hemoglobin, blood pressure and LDL-cholesterol, as considered in a combined fashion, and all-cause mortality in patients with type 2 diabetes mellitus. Two cohorts of patients with type 2 diabetes mellitus, the Gargano Mortality Study (n=810) and the Foggia Mortality Study (n=929), were investigated. A weighted target risk score was built as a weight linear combination of the recommended targets reached by each patient. In the Gargano Mortality Study and in the Foggia Mortality Study (mean follow up=7.4 and 5.5 years, respectively), 161 (19.9%) and 220 (23.7%) patients died, with an age and sex adjusted annual incidence rate of 2.1 and 2.8 per 100 person-years, respectively. In both study samples the weighted target risk score tended to be linearly associated with all-cause mortality (HR for one point increment=1.30, 95% CI: 1.11-1.53, p=0.001, and HR=1.08, 95% CI: 0.95-1.24, p=0.243, respectively). When the two cohorts were pooled and analyzed together, a clear association between weighted target risk score and all-cause mortality was observed (HR for one point increment=1.17, 95% CI:1.05-1.30, p=0.004). This counterintuitive association was no longer observable in a model including age, sex, body mass index, smoking habit, estimated glomerular filtration rate, albuminuria and anti-diabetic, anti-hypertensive and anti-dyslipidemic treatment as covariates (HR for one point increment=0.99, 95% CI: 0.87-1.12, p=0.852). In a real life clinical set of patients with type 2 diabetes mellitus, the combination of recommended target values of established cardiovascular risk factors is not associated with all-cause mortality.