Objective: To assess whether multifactorial interventions have long-term effects on the risk of diabetes-related macrovascular complications in patients with type 2 diabetes mellitus living in urban communities of Beijing. Design, setting and participants: A total of 2926 patients with type 2 diabetes from 15 community health centers were divided into a diabetes mellitus (DM) group (n=824), a hypertension (HTN) group (n=1267), and a cardiovascular disease (CVD) group (n=835). By applying Framingham risk scores (FRS), patients in the 3 groups were subdivided into low (FRS <10%), medium (FRS 10%-20%), and high (FRS >20%) Framingham risk strata. After 48 months, patients were followed-up to assess the long-term effects of the multifactorial interventions. Results: At baseline, the patients’ mean neck circumference (NC) was significantly higher in the HTN and CVD groups than in the DM group (P<0.05). After 48 months of follow-up, the CVD and HTN groups both had higher blood pressures and lipid levels than the DM group (both P<0.01). Although there was no significant change in the FRS versus baseline in the low and medium Framingham risk strata, a significant reduction in FRS was noted in the high Framingham risk strata. In Cox multivariate analyses, the HTN and CVD groups had higher incidences of endpoint events than the DM group. Conclusions: This study has demonstrated for the first time a relationship between NC and CVD in diabetic patients. Multifactorial interventions for CVD risk factors over 48 months lowered the estimated 10-year risk for CVD events in diabetes. FRS score influences the incidence of CVD events in diabetic patients. Aggressive risk reduction should be focused on these individuals who had high FRS score.
Xue-Lian Zhang, Shen-Yuan Yuan, Gang Wan, Liang-Xiang Zhu, Han-Jing Fu, Ming-Xia Yuan, Guang-Ran Yang, Su-Fang Pan, Rong-Rong XIE, Yu-Jie Lv, Ning Zhuang, Xue-Ping Du, Yu- Ling LI, Yu JI, Li Zhou, Yue L, Xue-Li Cui, Jie Miao, Zi-Ming Wang, Yu-Jie Chen, De-Yuan Liu, Shu-Yan Cheng, Ying Gao16 and Yi-Pin Wang