International Journal of General Medicine (Apr 2023)
Cardiovascular Risk Among Patients with Controlled and Uncontrolled Type 2 Diabetes: A Sub-Cohort Analysis from the Heart Health Promotion (HHP) Study
Abstract
Amel Fayed,1 Rasmieh Alzeidan,2 Roaa Elkouny,3 Marwa Tawfik,4 Rania Naguib5 1Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 2College of Medicine, Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia; 3College of Medicine, AlFaisal University, Riyadh, Saudi Arabia; 4Hepatobiliary Unit, Internal Medicine Department, Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt; 5Internal Medicine Department, Endocrinology Unit, Faculty of Medicine, Alexandria University, Alexandria, EgyptCorrespondence: Amel Fayed, Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box: 84428, Riyadh, 11671, Saudi Arabia, Tel +966 594 395 059, Email [email protected]: This study aimed to estimate the risk of cardiovascular disease (CVD) among patients with and without diabetes mellitus (DM) using the Framingham risk score (FRS) and to investigate the effect of DM control on CVD risk.Methodology: A total of 2432 participants who had their glycosylated hemoglobin (HbA1c) measured within the last three months were included in this study. The study cohort was divided into three categories: non-diabetic, participants with controlled DM (HbA1c< 7%), and uncontrolled DM (HbA1c≥ 7%). The World Health Organization’s stepwise approach to chronic disease risk factor Surveillance-Instrument v2.1 was used in this study to collect the anthropometric and biochemical measurements. The Framingham Coronary Heart Risk Score (FRS) was used to calculate the 10-year cardiovascular risk (CVR). The groups were compared concerning the prevalence of metabolic, socioeconomic, and cardiac risks.Results: Out of 2432 participants, 149 had controlled DM (6.1%), 286 had uncontrolled DM (11.8%), and 1997 participants were normoglycemic (82.1%). Compared to healthy participants, diabetic participants showed more high-risk characteristics across all CVR parameters. Uncontrolled diabetic patients had a graver laboratory and clinical profiles compared to the controlled DM group. As measured by FRS, nearly half of patients with controlled DM (49.9%) and two-thirds of patients with uncontrolled DM (63.3%) were classified as intermediate and high-risk compared to 4.6% of the healthy participants. Compared to healthy participants, patients with controlled DM showed a threefold increased CVR (OR = 3.02, 95% C.I. = 1.41– 7.24) while this risk catapulted to 13 times among those with uncontrolled DM (OR = 13.57, 95% C.I. = 6.99– 26.36).Conclusion: Participants with DM are at moderate to high CVR. Individuals with uncontrolled DM showed higher CVR profiles as measured by FRS and have a higher prevalence of obesity, unhealthy diet, and physical inactivity.Keywords: cardiovascular risk, diabetes, uncontrolled diabetes, Framingham risk score, Saudi Arabia
