SNOWMASS, COLO. — Optimal control of cardiovascular risk factors in diabetic patients in the community setting remains an elusive goal, according to the most recent data from the Framingham Heart Study.
Individuals with diabetes have a two- to threefold greater rate of cardiovascular disease than do those without the disease.
Aggressive control of their cardiovascular risk factors is essential to overcome this markedly increased risk. But the Framingham experience demonstrates that it is not happening, Dr. Patrick O'Gara observed at a conference sponsored by the American College of Cardiology.
A bright spot is the low prevalence of cigarette smoking, down to just under 13% during 2000–2005 in 60-year-olds with diabetes in Framingham. That's even lower than the 17% smoking rate among comparable-age individuals without diabetes.
This rejection of smoking by the Framingham diabetic population over the last 3 decades has been particularly impressive: The prevalence among 60-year-olds with diabetes has steadily fallen from nearly 42% during 1970–1979, to 27.5% in 1980–1989, 18% in 1990–1999, and down to 12.8% in the first half of the last decade, noted Dr. O'Gara of Brigham and Women's Hospital, Boston.
Hypertension is another story altogether. The prevalence of hypertension among 60-year-olds with diabetes in 2000–2005 was 87%, more than twice that of nondiabetic individuals.
Moreover, the prevalence of hypertension among the diabetic population was essentially unchanged since 1970.
The rate of controlled hypertension was less than 27% in 60-year-old diabetic men and women in Framingham during 2000–2005, compared with 45.5% in those without diabetes (Circulation 2009;120:212-20).
Only 40% of diabetic individuals with high LDL cholesterol had it controlled to guideline target levels in 2000–2005.
That's better than the 32% rate among those without diabetes, and a huge improvement over the 13.5% rate in diabetic 60-year-olds during 1990–1999, but a far cry from what is required to erase the high excess cardiovascular risk among the diabetic population, Dr. O'Gara noted.
The prevalence of obesity among diabetic 60-year-olds in 2000–2005 was more than 67%, up sharply from 46% during the prior decade.
The rise in obesity among nondiabetic 60-year-olds was considerably less dramatic, from a 26% prevalence in 1990–1999 to 33% in the most recent data.
“I think we all understand the magnitude of the problem and that some of the solutions to this problem are larger than what we can do on an individual basis, but I encourage us all to keep our eyes on the prize,” Dr. O'Gara concluded.
Disclosures: The Framingham Heart Study is funded by the National Heart, Lung, and Blood Institute. Dr. O'Gara reported having no relevant financial interests.