Heart Healthy Blog by Boston Heart

Targeting Better Heart Disease Prevention

Posted by Michael Dansinger, MD on Jun 2, 2016 11:32:00 AM

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Great news! A recently published study highlights and strengthens the evidence supporting a key principle and effective strategy in heart disease prevention. In this study1, published by the American Diabetes Association’s peer-reviewed journal Diabetes Care, Dr. Nathan Wong and colleagues demonstrate the tremendous health benefits of cumulative cardiovascular risk factor optimization.

The principle makes logical sense. Heart disease and atherosclerosis result from a complex combination of causes including abnormal levels of blood fats, blood sugar, blood pressure and inflammation. It stands to reason that controlling each abnormality by making it closer to normal should help prevent or delay heart disease, especially in patients at high risk for heart attacks and strokes. Similarly, those patients who have more uncontrolled risk factors would be expected to have higher rates of heart attacks and other cardiovascular events.

Importantly, the study demonstrates this principle very clearly. Over 2000 men and women with type 2 diabetes (but not cardiovascular disease), aged 28 to 86 years at study start, were followed for an average of 11 years. The investigators focused on measuring whether three risk factors were controlled: LDL (bad) cholesterol levels, average blood sugar levels (A1c), and blood pressure levels. They found that only 7% of study participants had good control of all three risk factors.

The risk of heart disease varied depending on how many factors they had controlled:

  • Individuals with all three factors controlled were 62% less likely to develop heart disease, compared to those with none of the three risk factors controlled.
  • Those with two out of three risk factors controlled were 52% less likely.
  • Those with one out of three were 36% less likely.

Each individual risk factor made a difference, and controlling each one added value.  These results match very closely with this previous study2—together these two studies demonstrate the principle of cumulative risk factor optimization for preventing heart disease and premature death via lifestyle modification and medications.

It is refreshing to have such clear direction in heart disease prevention! Unless proven otherwise, it stands to reason that this principle holds true for not just those patients with type 2 diabetes, but for all patients at risk for heart disease. Abnormal levels of modifiable risk factors each contribute to accelerated heart disease, and controlling all of them is better than controlling only some or none of them.

Sometimes studies looking at a single risk factor fail to demonstrate the value of improving that individual risk factor. Nevertheless, studies that look at controlling multiple risk factors simultaneously often achieve and demonstrate the most dramatic results, especially in individuals at the highest risk for life-threatening cardiovascular events.3-7

I believe the “target” for the future of heart disease prevention is to hit all the right targets in each at-risk patient. I am filled with optimism that clinicians and patients can work together to do much better in the future, and I am proud to help my patients in such an important way, backed by scientific evidence of better outcomes.

 

References:

  1. http://care.diabetesjournals.org/content/early/2016/03/29/dc15-2439.abstract
  2. http://www.nejm.org/doi/full/10.1056/nejmoa0706245
  3. http://www.sciencedirect.com/science/article/pii/S0140673604170189
  4. http://content.onlinejacc.org/article.aspx?articleID=1909605#tab1
  5. http://heart.bmj.com/content/81/4/380.short
  6. http://aje.oxfordjournals.org/content/162/8/764.full
  7. http://www.ncbi.nlm.nih.gov/pubmed/25398889

Topics: About Stroke, Diabetes and CVD