Composite cardiovascular risk factor control in US adults with diabetes and relation to social determinants of health: The All of Us research program
Background: Data are limited on composite cardiovascular risk factor control in patients with type 2 diabetes mellitus (T2DM). This study aims to identify disparities in cardiovascular risk factor control based on most recent recommendations and relationships to social determinants of health in a la...
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Elsevier
2025-03-01
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| Series: | American Journal of Preventive Cardiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666667725000121 |
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| author | Frances Golden Johnathan Tran Nathan D. Wong |
| author_facet | Frances Golden Johnathan Tran Nathan D. Wong |
| author_sort | Frances Golden |
| collection | DOAJ |
| description | Background: Data are limited on composite cardiovascular risk factor control in patients with type 2 diabetes mellitus (T2DM). This study aims to identify disparities in cardiovascular risk factor control based on most recent recommendations and relationships to social determinants of health in a large-scale real-world cohort of US adults. Methods: We analyzed data from 88,416 participants with T2DM in the NIH Precision Medicine Initiative All of Us Research Program 2018–2022. We investigated the management of five key cardiovascular risk factors—glycated hemoglobin (HbA1c), LDL cholesterol (LDL-C), body mass index (BMI), blood pressure (BP), and smoking status. Statistical methods included Chi-square tests for categorical comparisons, t-tests for mean differences, and multiple logistic regression to assess the impact of demographic and socioeconomic factors on risk factor control. Results: The study revealed low risk factor control with only 27.7 % of participants achieving recommended levels for three or more risk factors (RFs) and 4.9 % for four or more RFs. Overall, while 81.0% were at target for HbA1c, only 37.9% were at target for BP and 10.4% for LDL-C. Notably, only 1.9 % and 6.9 % were at target for HbA1c, LDL-C, and BP together, based on current and prior recommendations, respectively. Significant disparities were observed across race/ethnicity, sex, and socioeconomic lines with 43.1 % of Asian participants at control for ≥3 RFs compared to 21.1 % of non-Hispanic black participants. In logistic regression analysis, factors such as higher income, higher educational attainment, and health insurance were associated with better RF control, while higher polysocial risk scores linked to poorer control. Conclusions: Despite some progress in managing individual CVD risk factors in T2DM, overall composite risk factor control remains poor, especially among underrepresented and socioeconomically disadvantaged groups. The findings highlight the necessity for integrated healthcare strategies that address both medical and social needs to improve control of CVD risk factors and outcomes in T2DM. |
| format | Article |
| id | doaj-art-e5295b3cf1274d93a5f5ddba171523c1 |
| institution | Kabale University |
| issn | 2666-6677 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Preventive Cardiology |
| spelling | doaj-art-e5295b3cf1274d93a5f5ddba171523c12025-02-05T04:32:43ZengElsevierAmerican Journal of Preventive Cardiology2666-66772025-03-0121100939Composite cardiovascular risk factor control in US adults with diabetes and relation to social determinants of health: The All of Us research programFrances Golden0Johnathan Tran1Nathan D. Wong2Heart Disease Prevention Program, Division of Cardiology, University of California, C240 Medical Sciences, Irvine, CA 92697, United StatesHeart Disease Prevention Program, Division of Cardiology, University of California, C240 Medical Sciences, Irvine, CA 92697, United StatesCorresponding author.; Heart Disease Prevention Program, Division of Cardiology, University of California, C240 Medical Sciences, Irvine, CA 92697, United StatesBackground: Data are limited on composite cardiovascular risk factor control in patients with type 2 diabetes mellitus (T2DM). This study aims to identify disparities in cardiovascular risk factor control based on most recent recommendations and relationships to social determinants of health in a large-scale real-world cohort of US adults. Methods: We analyzed data from 88,416 participants with T2DM in the NIH Precision Medicine Initiative All of Us Research Program 2018–2022. We investigated the management of five key cardiovascular risk factors—glycated hemoglobin (HbA1c), LDL cholesterol (LDL-C), body mass index (BMI), blood pressure (BP), and smoking status. Statistical methods included Chi-square tests for categorical comparisons, t-tests for mean differences, and multiple logistic regression to assess the impact of demographic and socioeconomic factors on risk factor control. Results: The study revealed low risk factor control with only 27.7 % of participants achieving recommended levels for three or more risk factors (RFs) and 4.9 % for four or more RFs. Overall, while 81.0% were at target for HbA1c, only 37.9% were at target for BP and 10.4% for LDL-C. Notably, only 1.9 % and 6.9 % were at target for HbA1c, LDL-C, and BP together, based on current and prior recommendations, respectively. Significant disparities were observed across race/ethnicity, sex, and socioeconomic lines with 43.1 % of Asian participants at control for ≥3 RFs compared to 21.1 % of non-Hispanic black participants. In logistic regression analysis, factors such as higher income, higher educational attainment, and health insurance were associated with better RF control, while higher polysocial risk scores linked to poorer control. Conclusions: Despite some progress in managing individual CVD risk factors in T2DM, overall composite risk factor control remains poor, especially among underrepresented and socioeconomically disadvantaged groups. The findings highlight the necessity for integrated healthcare strategies that address both medical and social needs to improve control of CVD risk factors and outcomes in T2DM.http://www.sciencedirect.com/science/article/pii/S2666667725000121DiabetesCardiovascular diseaseRisk factorsSocial determinants of health |
| spellingShingle | Frances Golden Johnathan Tran Nathan D. Wong Composite cardiovascular risk factor control in US adults with diabetes and relation to social determinants of health: The All of Us research program American Journal of Preventive Cardiology Diabetes Cardiovascular disease Risk factors Social determinants of health |
| title | Composite cardiovascular risk factor control in US adults with diabetes and relation to social determinants of health: The All of Us research program |
| title_full | Composite cardiovascular risk factor control in US adults with diabetes and relation to social determinants of health: The All of Us research program |
| title_fullStr | Composite cardiovascular risk factor control in US adults with diabetes and relation to social determinants of health: The All of Us research program |
| title_full_unstemmed | Composite cardiovascular risk factor control in US adults with diabetes and relation to social determinants of health: The All of Us research program |
| title_short | Composite cardiovascular risk factor control in US adults with diabetes and relation to social determinants of health: The All of Us research program |
| title_sort | composite cardiovascular risk factor control in us adults with diabetes and relation to social determinants of health the all of us research program |
| topic | Diabetes Cardiovascular disease Risk factors Social determinants of health |
| url | http://www.sciencedirect.com/science/article/pii/S2666667725000121 |
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