Projected Impact of LDL-C and HbA1c Control on Cardiovascular Outcomes in ASCVD and Diabetes.

BACKGROUND

U.S. population estimates of atherosclerotic cardiovascular disease (ASCVD) risk reduction from comprehensive cardiometabolic risk factor control remain limited among patients with ASCVD and diabetes mellitus (DM).

OBJECTIVES

The objective of the study was to predict 3-year reduction in composite ASCVD event risk and number of preventable events associated with achieving guideline-based targets for low-density lipoprotein cholesterol (LDL-C) and/or hemoglobin A1c (HbA1c) in adults with ASCVD and DM. Among those with body mass index (BMI) ≥27 kg/m2, we additionally examined the impact of reducing BMI to 25 kg/m2.

METHODS

Using National Health and Nutrition Examination Survey 2011 to 2020 data weighted to the U.S. population, we identified adults with ASCVD and DM with uncontrolled LDL-C (≥70 mg/dL) and HbA1c (≥7.0%). Three-year ASCVD risk was calculated using the TIMI risk score. Absolute risk was first estimated with patients' baseline LDL-C, HbA1c, and BMI values, then recalculated under scenarios achieving guideline-recommended targets (70 or 55 mg/dL, 7%, and 25 kg/m2, respectively). Predicted relative risk reductions and predicted preventable events over 3 years were calculated.

RESULTS

We included 131 participants, representing 1.73 million U.S. adults. Predicted 3-year relative risk reductions were 18.0% and 23.7%, corresponding to 38,200 and 50,100 predicted preventable events, with LDL-C lowering to 70 mg/dL or 55 mg/dL, respectively; 29.3%, corresponding to 62,100 events, with additional control of HbA1c; and 37.0%, corresponding to 66,500 events, with additional BMI reductions.

CONCLUSIONS

In U.S. adults with ASCVD and DM, LDL-C control provides the greatest projected reduction in ASCVD risk among individual risk factors, whereas comprehensive control of LDL-C, glycemia, and weight produces the greatest overall projected benefit.