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Blood pressure and cardiovascular disease risk in the Veterans Affairs Diabetes Trial.

ABSTRACT: Blood pressure ranges associated with cardiovascular disease (CVD) events in advanced type 2 diabetes are not clear. Our objective was to determine whether baseline and follow-up (On-Study) systolic blood pressure (SBP), diastolic blood pressure (DBP), and SBP combined with DBP predict CVD events in the Veterans Affairs Diabetes Trial (VADT).Participants in the VADT (n = 1,791) with hypertension received stepped treatment to maintain blood pressure below the target of 130/80 mmHg in standard and intensive glycemic treatment groups. Blood pressure levels of all subjects at baseline and On-Study were analyzed to detect associations with CVD risk. The primary outcome was the time from randomization to the first occurrence of myocardial infarction, stroke, congestive heart failure, surgery for vascular disease, inoperable coronary disease, amputation for ischemic gangrene, or CVD death.Separated SBP ?140 mmHg had significant risk at baseline (hazards ratio [HR] 1.508, P < 0.001) and On-Study (HR 1.469, P = 0.002). DBP <70 mmHg increased CVD events at baseline (HR 1.482, P < 0.001) and On-Study (HR 1.491, P < 0.001). Combined blood pressure categories indicated high risk for CVD events for SBP ?140 with DBP <70 mmHg at baseline (HR 1.785, P = 0.03) and On-Study (HR 2.042, P = 0.003) and nearly all SBP with DBP <70 mmHg.Increased risk of CVD events with SBP ?140 mmHg emphasizes the urgency for treatment of systolic hypertension. Increased risk with DBP <70 mmHg, even when combined with SBP in guideline-recommended target ranges, supports a new finding in patients with type 2 diabetes. The results emphasize that DBP <70 mmHg in these patients was associated with elevated CVD risk and may best be avoided.

SUBMITTER: Anderson RJ

PROVIDER: S-EPMC3005453 | biostudies-literature | 2011 Jan

REPOSITORIES: biostudies-literature

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Blood pressure and cardiovascular disease risk in the Veterans Affairs Diabetes Trial.

Anderson Robert J RJ Bahn Gideon D GD Moritz Thomas E TE Kaufman Derrick D Abraira Carlos C Duckworth William W

Diabetes care 20101108 1

<h4>Objective</h4>Blood pressure ranges associated with cardiovascular disease (CVD) events in advanced type 2 diabetes are not clear. Our objective was to determine whether baseline and follow-up (On-Study) systolic blood pressure (SBP), diastolic blood pressure (DBP), and SBP combined with DBP predict CVD events in the Veterans Affairs Diabetes Trial (VADT).<h4>Research design and methods</h4>Participants in the VADT (n = 1,791) with hypertension received stepped treatment to maintain blood pr ...[more]

PMID: 21059830

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Project description:Importance:Current guidelines recommend statin therapy for millions of US residents for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). It is unclear whether traditional prediction models that do not account for current widespread statin use are sufficient for risk assessment. Objectives:To examine the performance of the Pooled Cohort Equations (PCE) for 5-year ASCVD risk estimation in a contemporary cohort and to test the hypothesis that inclusion of statin therapy improves model performance. Design, Setting, and Participants:This cohort study included adult patients in the Veterans Affairs health care system without baseline ASCVD. Using national electronic health record data, 3 Cox proportional hazards models were developed to estimate 5-year ASCVD risk, as follows: the variables and published ? coefficients from the PCE (model 1), the PCE variables with cohort-derived ? coefficients (model 2), and model 2 plus baseline statin use (model 3). Data were collected from January 2002 to December 2012 and analyzed from June 2016 to March 2020. Exposures:Traditional ASCVD risk factors from the PCE plus baseline statin use. Main Outcomes and Measures:Incident ASCVD and ASCVD mortality. Results:Of 1?672?336 patients in the cohort (mean [SD] baseline age 58.0 [13.8] years, 1?575?163 [94.2%] men, 1?383?993 [82.8%] white), 312?155 (18.7%) were receiving statin therapy at baseline. During 5 years of follow-up, 66?605 (4.0%) experienced an ASCVD event, and 31?878 (1.9%) experienced ASCVD death. Compared with the original PCE, the cohort-derived model did not improve model discrimination in any of the 4 age-sex strata but did improve model calibration. The PCE overestimated ASCVD risk compared with the cohort-derived model; 211?237 of 1?136?161 white men (18.6%), 29?634 of 218?463 black men (13.6%), 1741 of 44?399 white women (3.9%), and 836 of 16?034 black women (5.2%) would be potentially eligible for statin therapy under the PCE but not the cohort-derived model. When added to the cohort-derived model, baseline statin therapy was associated with a 7% (95% CI, 5%-9%) lower relative risk of ASCVD and a 25% (95% CI, 23%-28%) lower relative risk for ASCVD death. Conclusions and Relevance:In this study, lower than expected rates of incident ASCVD events in a contemporary national cohort were observed. The PCE overestimated ASCVD risk, and more than 15% of patients would be potentially eligible for statin therapy based on the PCE but not on a cohort-derived model. In the statin era, health care professionals and systems should base ASCVD risk assessment on models calibrated to their patient populations.

Dataset Information

Blood pressure and cardiovascular disease risk in the Veterans Affairs Diabetes Trial.

Publications

Blood pressure and cardiovascular disease risk in the Veterans Affairs Diabetes Trial.

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