Abstract
The evidence-based practice guideline for diabetes treatment in Japan recommends HbA1C of <6.5%, blood pressure of <130/80 mmHg, and LDL-cholesterol of <120 mg/dl. To determine the impact of guideline adherence on cardiovascular event incidence, we evaluated 6-year follow-up data on 368 subjects with type 2 diabetes but no cardiovascular disease history. The endpoint was defined as acute myocardial infarction, angina pectoris, stroke, or sudden death. The 51 reaching an endpoint during follow-up were significantly older and had higher systolic blood pressure, HbA1C, plasma glucose, and LDL-cholesterol, and lower HDL-cholesterol than event-free subjects. Those achieving the guideline target of HbA1C <6.5% were 27.5% for events vs. 45.4% for event-free (p<0.05) . Similarly, those achiering the targeted blood pressure <130/80 mmHg were 15.7% vs. 42.0% (p<0.01) and of LDL-cholesterol <120 mg/dl were 68.6% vs. 70.3% (not significant) . In achievement by category number 0 or 1, 2, or 3-Kaplan-Meier survival analysis indicated a difference in cardiovascular event rate (p<0.01) . Event rate reduction was 64.4% for subjects achieving 2 categories and 79.9% for 3 vs. 0 or 1 category-similar to Cox's proportional hazard model of hazard ratio reduction, i.e., 68.7 for 2 categories and 82.6% for 3. Guideline adherence is thus prognostically beneficial in preventing cardiovascular events in Japanese subjects with diabetes, whose cardiovascular event incidence was clearly reduced when at least two guideline categories were achieved.
