Achieving sustained reductions of hyperlipidemia and blood pressure in a patient with diabetes is not impossible, but it's a challenge. A new study comparing two health systems shows which factors increase the odds of success.
Believe it or not, as many as 30% of patients with the trifecta of cardiovascular risk factors are able to achieve control of HbA1c, blood pressure, and low-density lipoprotein (LDL) cholesterol at the same time. These results from two very different healthcare systems in Denver, as measured over the course of years, show that estimates from earlier studies of the question are unduly pessimistic.
However, the factors that correlate with success are not necessarily the ones that you might predict. In this podcast, Dr. John F. Steiner describes the study and its implications for primary care physicians. Dr. Steiner is senior director of the Institute for Health Research at Kaiser Permanente Colorado and professor of general internal medicine at the University of Colorado School of Medicine.
Clues to Simultaneous Control of Diabetes, Hypertension, and Hyperlipidemia
1. What were you looking to learn, and what did you measure?
2. What was already known abou the likelihood of simultaneous control of all 3 risk factors?
3. How did your results differ?
4. Please tell us about the contribution of primary care visits and the frequency of risk factors.
The take-home points:
♦ Simultaneous control of hypertension, diabetes, and hyperlipidemia is more possible than previously thought.
♦ But it is difficult to sustain for more than a few months.
♦ Sociodemographic factors such as age, race, and gender do not predict which patients are likely to achieve simultaneous control of all 3 risk factors.
♦ The frequency of visits to doctors and the regularity of intervals at which HbA1c, blood pressure, and LDL are measured do not correlate particularly well with success in controlling these risk factors simultaneously.
♦ The two factors that most significantly predict success are the severity of the underlying conditions and the degree of adherence to medications.
Schroeder EB, Hanratty R, Beaty BL, Bayliss EA, Havranek EP, Steiner JF. Simultaneous control of diabetes mellitus, hypertension, and hyperlipidemia in 2 heatlh systems.
Circ Cardiovasc Qual Outcomes. July 31, 2012. Available at http://circoutcomes.ahajournals.org/content/early/2012/07/31/CIRCOUTCOMES.111.963553.abstract