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Trends in Cardiovascular Risk Factors for Diabetics and Non-diabetics

A recent study examined the trends in cardiovascular risk factors and intervention measures in diabetics and non-diabetics between 1998 and 2014.

Cardiovascular disease (CVD) remains a leading cause of death associated with diabetes. However, over the past decades, the prevalence of death due to cardiovascular disease in diabetics has decreased. Past studies have examined cardiovascular mortality trends in diabetics demonstrating an overall decline from improvements in lowering cardiovascular risk factors and advancements in treatments.

In an article published in BMC Public Health, researchers in China studied cardiovascular risk factor trends in both men and women, with and without diabetes in the United States. Data was collected from five consecutive National Health and Nutrition Examination Surveys spanning a period from 1988 to 2014. Survey participants completed a standardized questionnaire, had an at-home interview, and underwent physical examinations and laboratory measurements. The study analyzed nine traditional cardiovascular risk factors: body mass index (BMI), waist circumference, blood pressure, total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, non-HDL cholesterol, and smoking status.

How Have the Risk Factors Changed?

The analysis found an increasing trend in mean BMI and waist circumference in diabetics and non-diabetics in both genders. In diabetics, the absolute increase of BMI and waist circumference levels were comparable among men and women, but the mean waist circumference levels in non-diabetic women were greater than in non-diabetic men.

The mean systolic blood pressure in both men and women were observed to have a similar degree of decrease for both diabetics and non-diabetics. When adjusted for age, the mean levels of total cholesterol, LDL-cholesterol, and non-HDL cholesterol had a linear decline among all diabetic and non-diabetic men and women, and in women, there was a greater decline over time in diabetics than non-diabetics.

Smoking status was also seen to have a decreased prevalence in all diabetic and non-diabetic men and women groups, with similar rates of decrease for both genders. Across all groups, there was an overall increase in the prevalence of antihypertensive and lipid-lowering medication use (greater in diabetics than non-diabetics) and in achieving target blood pressure and lipid levels (greater in women than in men).

What are the Implications of the Study?

When examining the association between diabetes and gender, the study didn’t find any statistically significant difference for the studied cardiovascular risk factors, except HDL cholesterol. This suggests that differences in cardiovascular risk factors between diabetics and non-diabetics did not differ by gender.

Overall, the study found that between 1998 and 2014, diabetic men and women experienced similar declines in blood pressure, cholesterol levels, and smoking status and a similar increase in rates of achieving blood pressure and LDL-cholesterol targets compared to non-diabetics.

These favourable changes may be attributed to several factors, which may include healthier lifestyles and increased medication use. Thus, diabetic men and women may be at a lower cardiovascular risk than in past decades. Observations from the study demonstrate the increasing improvements in healthcare and diabetes management in recent years. Continued efforts to reduce cardiovascular risk factors remain essential as strong clinical evidence supports the benefits of achieving a healthy blood pressure, along with lipid and glucose control, to prevent cardiovascular mortality.

Written by Maggie Leung, PharmD

Reference: Sun, X., & Du, T. (2017). Trends in cardiovascular risk factors among U.S. men and women with and without diabetes, 1988–2014. BMC Public Health, 17(1). doi:10.1186/s12889-017-4921-4.

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