Advanced Cardiovascular-Kidney-Metabolic Risk and Risk-Factor Control in Patients With Type 2 Diabetes Without Established Cardiovascular Disease.

BACKGROUND

Cardiovascular-kidney-metabolic (CKM) risk stratification may identify patients with type 2 diabetes mellitus (T2DM) who require more intensive primary prevention, but real-world data from Vietnam are limited. We aimed to describe advanced CKM risk and risk-factor control in Vietnamese patients with T2DM without established cardiovascular disease (CVD).

METHODS

This multicenter cross-sectional study enrolled 1436 adults with T2DM without CVD in Vietnam. Advanced CKM risk was defined as 10-year total CVD risk ≥ 20% or eGFR < 60 mL/min/1.73 m2. Guideline-based control of HbA1c, blood pressure, LDL-C, triglycerides, and non-HDL-C was evaluated. Logistic regression assessed associations between advanced CKM risk and target achievement.

RESULTS

Advanced CKM risk was identified in 551 patients (38.4%). Despite a relatively low prevalence of BMI ≥ 25 kg/m2 (26.9%), hypertriglyceridemia was the most common metabolic abnormality, affecting 88.0% of participants. Risk-factor control was generally low, with 33.3% achieving glycemic control, 33.5% blood pressure control, 18.8% LDL-C control, 12.0% triglyceride control, and 21.1% non-HDL-C control. After adjustment, advanced CKM risk was associated with poorer blood pressure control (adjusted OR = 0.466, 95% CI = 0.359-0.603, p < 0.001) and triglyceride control (adjusted OR = 0.677, 95% CI = 0.473-0.969, p = 0.033), but not with achievement of HbA1c, LDL-C, non-HDL-C, or combined lipid control.

CONCLUSIONS

Advanced CKM risk was common among Vietnamese patients with T2DM without established CVD and was consistently associated with poorer blood pressure control. CKM-based risk assessment may identify high-risk patients earlier and support guideline-directed risk-factor management. Frequent hypertriglyceridemia with relatively low obesity supports a CKM-based strategy tailored to this metabolic risk pattern.