Effect of Number of Achieved Targets for Risk Factors on Coronary Artery Disease (CAD) in Those With and Without Diabetes Mellitus (DM)

Although control of multiple risk factors is essential to prevent CAD in persons with and without DM, longitudinal studies are scarce that directly and quantitatively compared effects of such control in DM and non-DM. Thus, we investigated effects on subsequent CAD of the number of controlled risk factors among blood pressure, LDL cholesterol and HbA1c using a nationwide claim-based database (median follow-up 4.8 y) in Japan. Targets were based on ADA and Japanese guidelines. Of 207,029 non-DM persons, 42.8% and 37.9% were at target for 1 and 2 factors, respectively. Of 13,471 persons with DM, 39.5%, 32.1%, and 10.0% were at target for 1, 2, and 3 factors, respectively. Multivariate Cox analysis showed reduced CAD risk with increased numbers of risk factor targets reached in DM compared to non-DM (Table, upper). However, in DM, although fulfillment of the target for only 1 risk factor significantly elevated the hazard ratio (HR) (i.e., 1.98 (1.28-3.07)) to non-significance (i.e., 1.03 (0.68-1.66)), no further significant HR reduction below reference (i.e., non-DM with no target achieved) was found (Table, lower). These findings show that composite control of modifiable risk factors has a larger effect in DM compared to non-DM, but the effect was not sufficient to bring CAD risk in DM below that for non-DM persons with none of 3 risk factors being at target based on current target levels.