Cardiovascular disease in type 2 diabetes: Attributable risk due to modifiable risk factors.

OBJECTIVE To examine the common clinical and behavioural factors that contribute to cardiovascular disease (CVD) risk (ie, attributable risk) among those with type 2 diabetes. DESIGN Analysis of data from a larger observational study. Using the validated UK Prospective Diabetes Study risk engine, the primary analysis examined the prevalence and attributable risk of CVD for 4 factors. Multivariable models also examined the association between attributable CVD risk and appropriate self-management behaviour. SETTING Twenty primary health care clinics in the South Texas area of the United States. PARTICIPANTS A total of 313 patients with type 2 diabetes mellitus currently receiving primary care services for their condition. MAIN OUTCOME MEASURES Prevalence of elevated CVD risk factors (glycated hemoglobin [HbA(1c)] levels, blood pressure, lipid levels, and smoking status), the attributable risk owing to these factors, and the association between attributable risk of CVD and diet, exercise, and medication adherence. RESULTS The mean 10-year CVD risk for the study population (N = 313) was 16.2%, with a range of 6.5% to 48.5% across clinics; nearly one-third of this total risk was attributable to modifiable factors. The primary variable driving risk reduction was HbA(1c) levels, followed by smoking status and lipid levels. Patients who were carefully engaged in monitoring their diets and medications reduced their CVD risk by 44% and 39%, respectively (P < .03). CONCLUSION Patients with diabetes experience a substantial risk of CVD owing to potentially modifiable behavioural factors. High-quality diabetes care requires targeting modifiable patient factors strongly associated with CVD risk, including self-management behaviour such as diet and medication adherence, to better tailor clinical interventions and improve the health status of individuals with this chronic condition.