[Achievement of behavioral and metabolic factors control targets on atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus].

Objective

To assess the long-term risk of atherosclerotic cardiovascular disease (ASCVD) in patients with type 2 diabetes mellitus (T2DM) managed under the National Essential Public Health Services Program and explore the relationship between behavioral/metabolic factor control and ASCVD risk.

Methods

This retrospective study included patients with T2DM who were enrolled in the National Essential Public Health Services Program. Baseline data from follow-up visits and physical examinations in 2018 were collected to evaluate 10-year ASCVD risk using the Prediction for Atherosclerotic Cardiovascular Disease Risk in China model. Follow-up continued until December 31, 2024, with ASCVD occurrence as the primary outcome. A competing-risk Cox proportional hazards regression model was used to analyze the impact of metabolic and behavioral factors on the risk of ASCVD. The "averisk" package in R 4.4.2 software was employed to estimate the population attributable risk (PAR) of ASCVD associated with these factors.

Results

A total of 27 877 T2DM patients were included in 2018. Over a median (Q1, Q3) follow-up of 75 (60, 77) months, 4 115 ASCVD events and 1 602 non-ASCVD deaths occurred, with a cumulative ASCVD incidence of 17.18%. Baseline ASCVD risk stratification (low-, medium-, and high-risk groups) revealed cumulative incidence rates of 4.24%, 11.91%, and 22.26%, respectively (P<0.001). Achieving control targets for FPG, blood pressure, non-HDL-C, waist circumference, smoking, and physical activity reduced ASCVD risk by 15% (HR=0.85, 95%CI: 0.80-0.91), 11% (HR=0.89, 95%CI: 0.84-0.95), 23% (HR=0.77, 95%CI: 0.72-0.83), 10% (HR=0.90, 95%CI: 0.85-0.96), 17% (HR=0.83, 95%CI: 0.76-0.91), and 5% (HR=0.95, 95%CI: 0.89-1.03), respectively. Simultaneous control of all six factors could prevent 60% (HR=0.40, 95%CI: 0.31-0.53) of ASCVD events. The PAR for ASCVD attributed to these six factors was 33.21% (95%CI: 27.52%-38.91%).

Conclusions

For T2DM patients managed under the National Essential Public Health Services Program, early achievement of metabolic and behavioral factor control targets significantly reduces ASCVD risk at both individual and population levels. Future efforts should focus on optimizing community-based health management strategies tailored to T2DM patients, with an emphasis on metabolic and behavioral interventions, to further reduce ASCVD risk in this population.