Open AccessMaintenance of Cardiovascular Risk Goals in Veterans With Diabetes After Discharge from a Cardiovascular Risk Reduction Clinic
Author(s) -
Pirraglia Paul A.,
Taveira Tracey H.,
Cohen Lisa B.,
Dooley Andrea,
Wu WenChih
Publication year - 2009
Publication title -
preventive cardiology
Language(s) - English
Resource type - Journals
eISSN - 1751-7141
pISSN - 1520-037X
DOI - 10.1111/j.1751-7141.2008.00017.x
Subject(s) - medicine , hazard ratio , glycemic , blood pressure , diabetes mellitus , body mass index , cardiology , confidence interval , proportional hazards model , heart failure , insulin , endocrinology
The authors evaluated maintenance of achieved cardiovascular risk control after discharge from a pharmacist‐coordinated cardiovascular risk reduction clinic. Using data from 2001 to 2004 divided by financial quarters (ie, 3‐month periods), the authors performed survival analysis of diabetic patients who had attained at least one cardiovascular risk goal in the clinic. Mean times to failure were 7.1±0.21 quarters for hemoglobin A1c, 7.6±0.29 quarters for low‐density lipoprotein cholesterol (LDL‐C), and 2.5±0.24 quarters for systolic blood pressure (SBP). Body mass index predicted glycemic control failure (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.01–1.15; P =.02), insulin use predicted LDL‐C control failure (HR, 3.08; 95% CI, 1.15–8.22; P =.03), and baseline SBP predicted SBP control failure (HR, 1.02; 95% CI, 1.01–1.03; P =.0003). The authors found good durability of effect for most cardiovascular risk targets. Worse control at entry predicted failure after successful attainment of a cardiovascular goal. More sustained attention or booster interventions for patients with worse control at entry may be necessary.