Hamada S, et al. - In this population-based cohort study, researchers investigated the effectiveness of multiple risk factor control (MRFC) at reducing mortality and cardiovascular events in diabetes and chronic kidney disease (CKD) in clinical practice. MRFC consisted of four components: Haemoglobin A1c (HbA1c) <53 mmol/mol (<7.0%), blood pressure <140/90 mm Hg, total cholesterol <5 mmol/L and no smoking. As per findings, MRFC have the potential to lower the increased risks for mortality and cardiovascular events in people with diabetes and CKD.

Methods

• Population-based cohort study performed utilizing primary care database in the UK, linked with inpatient and mortality data.
• For this study, included participants were aged 40–79 years, had type 2 diabetes and valid serum creatinine measurements; 11,431 participants had CKD (estimated glomerular filtration rate: eGFR 15–59 mL/min/1.73 m²) and 36,429 participants had non-CKD (eGFR 7ge;60 mL/min/1.73 m²).
• The number of risk factors controlled at baseline was the main exposure variable.
• All-cause and cardiovascular mortality were assessed as the outcome measures in the overall participants.
• Outcome measures also included cardiovascular events, including coronary heart disease and stroke, in participants limited to those without a history of cardiovascular diseases at baseline.

Results

• Researchers noted that 37% or 13% met three or four MRFC criteria, respectively, among participants with CKD.
• Lower relative hazards for all outcomes studied were noted in association with increasing numbers of risk factors controlled compared with those meeting no or one criterion.
• The adjusted HR for all-cause mortality was 0.60 (95% CI 0.53 to 0.69) and the adjusted subdistribution HR for cardiovascular mortality was 0.60 (95% CI 0.50 to 0.70), considering a competing risk of non-cardiovascular death for participants with CKD meeting four criteria.
• Lower relative hazards for coronary heart disease (adjusted subdistribution HR 0.73, 95% CI 0.59 to 0.91) and stroke (0.63, 95% CI 0.45 to 0.89), considering death as a competing risk were also noted among participants meeting four criteria.