Treatment of cardiac risk factors in diabetic patients: How well do we follow the guidelines?

Background Diabetic patients are at increased risk for both macrovascular a nd microvascular disease compared with nondiabetic patients. Methods We conducted a prospective observational study to assess the contro l of multiple predetermined cardiovascular risk factors in 235 treated diab etic patients undergoing elective cardiac catheterization at our institutio n between December 20, 1997, and February 15, 2000. The following parameter s were used to define optimal treatment in these patients: hemoglobin (Hgb) A1c <7%, low-density lipoprotein cholesterol (LDL-c) < 100 mg/dL, high-den sity lipoprotein cholesterol (HDL-c) greater than or equal to 45 mg/dL for men and greater than or equal to 55 mg/dL for women, triglyceride (TG) leve l < 200 mg/dL, blood pressure (BP) < 130/85 mm Hg, body mass index (BMI) < 25, daily aspirin therapy, and current nonsmoking status. The use of beta - blockers and. angiotensin-converting enzyme inhibitors was also evaluated. Results The average patient age was 64 +/- 11 years; 155 (65%) were male. O ne hundred ninety-one (81%) patients had documented coronary artery disease at cardiac catheterization. The mean Hgb A1c level for all diabetic patien ts was 8.2% +/- 1.6%. Overall, 49 (21%) had an Hgb A1c level <7%. The fasti ng cholesterol panel for all patients revealed a mean LDL-c level of 103 +/ - 41 mg/dL, a mean HDL level of 39 +/- 11 mg/dL, and a mean TG level of 164 +/- 128 mg/dL. One hundred sixteen (52%) patients had an LDL-c <100 mg/dL. Only 32 of 147 (22%) male patients and 14 of 80 (18%) female patients achi eved an HDL-c <greater than or equal to>45 mg/dL or greater than or equal t o 55 mg/dL, respectively. One hundred seventy-seven of 232 (76%) patients h ad a TG level < 200 mg/dL. Only 23 of 233 (10%) diabetics were controlled t o a BP of <130/85 mm Hg, and 25 (11%) achieved a BMI <25. Only one patient (0.4%) had optimal control of all modifiable risk factors. Conclusions These data demonstrate the poor control of numerous cardiovascu lar risk factors in treated diabetics undergoing elective cardiac catheteri zation.