The benefits of intensively modifying risk factors for cardiovascular disease (CVD) vary widely in people with diabetes, researchers claim.
Their study revealed that patients at the highest CVD risk may account for nearly all the benefits of treating to target levels of low-density lipoprotein (LDL) cholesterol and blood pressure.
In contrast, they report that patients who were at average risk – comprising nearly three-quarters of the population – received “very little benefit.”
The findings lead the investigators to recommend tailoring treatment for individual patients based on the expected benefit of intensifying treatment.
And they go even further to warn: “Current treatment approaches that encourage uniformly lowering risk factors to common target levels can be both inefficient and cause unnecessary harm.”
The team developed a simulation model for a treat-to-target strategy with goals of 100 mg/dl (2.59 mmol/l) for LDL cholesterol and 130/80 mmHg for blood pressure using risk factor reductions obtained in clinical trials.
This was applied to several million individuals aged 30 to 75 years buy
Treating to targets resulted in a gain of 1.50 quality-adjusted life-years (QALYs) of lifetime treatment-related benefit for LDL cholesterol and 1.35 QALYs for blood pressure.
This declined to 1.42 and 1.16 QALYs, respectively, after accounting for treatment-related harms.
Most of the benefit was limited to the first few steps of intensifying medication or to tight control for a limited group of high-risk patients, Justin Timbie (RAND Health, Arlington, Virginia, USA) and co-workers report.
Indeed, they say that intensifying treatment beyond the first step for LDL cholesterol or the third step for blood pressure resulted in limited benefits or net harm for patients at below-average risk.
Reporting in the Archives of Internal Medicine, the researchers say most primary prevention guidelines are moving more strongly than those for diabetes toward basing recommendations on an individual patient’s calculated CVD risk.