Physicians' Academy for Cardiovascular Education

Stepwise reduced CV risk with each risk factor variable within target range in T2DM patients

Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes

Literature - Rawshani A, Rawshani A, Franzén S et al. - N Engl J Med 2018:379;7

Introduction and methods

T2DM patient have 2-4 times higher risk of death and CV events, compared to general population [1], but a long-lasting decreased risk has been shown in patients with a reduced number of risk factors after behavior modification or pharmacologic therapy [2-3]. However, the extent to which the excess CV risk in T2DM may be mitigated or even eliminated remains unclear.

This study evaluated the association between the number of risk-factor variables within target ranges based on guideline-recommended target levels [4-5] and the excess risk of death and CV outcomes in T2DM patients. Furthermore, the predicting value of various risk factors in the risk of death and CV outcomes was examined.

This cohort study included 271,174 T2DM patients (mean age 60.6 years) who were registered in the Swedish National Diabetes Register between January 1998 and December 2012, matched with 1,355,870 controls registered in the Swedish population register with a mean follow-up of 5.7 years. Age and the following five risk factors were assessed: elevated glycated hemoglobin (HbA1c) level (cutoff value ≥7.0%) , elevated low-density lipoprotein cholesterol (LDL-c) levels (cutoff value ≥2.5 mmol/L), albuminuria (presence of micro or macroalbuminuria), smoking, and elevated blood pressure (BP) (cutoff value ≥140 mmHg for systolic BP or >80 mmHg for diastolic BP).

The primary outcome consisted of all-cause death, fatal or non-fatal acute myocardial infarction (MI), fatal or non-fatal stroke, and hospitalization for heart failure (HF).

Main results

Risk of CV events

Predictive value risk-factors


T2DM patients with five risk-factor variables within guideline-recommended target ranges have no excess risk of death, stroke and MI, compared to general Swedish population, demonstrating the importance of behavior modification or pharmacologic therapy in T2DM patients.


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Find this article online at N Engl J Med

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