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Research article:

Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study

Reference:

Evangelos Kontopantelis, David A Springate, David Reeves, Darren M Ashcroft, Martin Rutter, Iain Buchan, Tim Doran(2015) Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study. Diabetologia, doi: 10.1007/s00125-014-3473-8

Link to fulltext article
Abstract
Background: Observational data have been used to inform target levels for modifiable risk factors in type 2 diabetes but these data are limited by confounding. We aimed to describe the shape of observed relationships between risk factor levels and clinically important outcomes in type 2 diabetes after adjusting for multiple confounders. Methods: We used retrospective longitudinal data on 246,544 adults with type 2 diabetes from 600 practices contributing to the Clinical Practice Research Datalink between 2006 and 2012. Proportional hazards regression models quantified the risks of mortality, microvascular or macrovascular events associated with four modifiable risk factors: glycated haemoglobin (HbA1c), systolic and diastolic blood pressure and total cholesterol, while controlling for numerous patient and practice covariates. Findings: U-shaped relationships were observed between all-cause mortality and levels of the four risk factors. The lowest risks were associated with HbA1c 7.25-7.75%; total cholesterol 3.5-4.5 mmol/L; systolic blood pressure 135-145 mmHg; and diastolic blood pressure 82.5-87.5 mmHg. coronary and stroke mortality related to the four risk factors in a positive, curvilinear way, with the exception of blood pressure which related to coronary deaths in a U-shape. Macrovascular events showed a positive and curvilinear relationship with HbA1c but U-shaped for total cholesterol and systolic blood pressure. Microvascular related to the four risk factors in a curvilinear way: positive for HbA1c and systolic blood pressure but negative for cholesterol and diastolic blood pressure. Interpretation: We identified several relationships which, when considered in the light of relevant trial data, support a call for major changes to clinical practice. Most importantly, our results support trial data indicating that normalisation of glucose and blood pressure can lead to poorer outcomes, which makes a strong case for target ranges for these risk factors rather than target levels.
Author for correspondence
Evangelos Kontopantelis
Email for correspondence
E.Kontopantelis@manchester.ac.uk

Code list: res9: lipid_lowering_other

76 codes in list

Code Coding system Description Entity type List name multilexcode bnfcode bnfchapter
10094 CPRD_product_code NIASPAN TITRATION PACK modified release tablet 375mg + 500mg + 750mg [ABBOTT] drug res9: lipid_lowering_other 12151001 2120500 Nicotinic acid group
11785 CPRD_product_code colestyramine powder sugar-free 4g drug res9: lipid_lowering_other 6458001 01090200/02120100 Bile acid sequestrants/Bile acid sequestrants (lipid-regulating drugs)
11976 CPRD_product_code NIASPAN modified release tablet 500mg [ABBOTT] drug res9: lipid_lowering_other 12147001 2120500 Nicotinic acid group
1212 CPRD_product_code colestipol granules drug res9: lipid_lowering_other 5337001 2120100 Bile acid sequestrants (lipid-regulating drugs)
1214 CPRD_product_code BEZALIP mono-tablets 400mg [ROCHE] drug res9: lipid_lowering_other 2104002 2120300 Fibrates
1215 CPRD_product_code fenofibrate capsules 100mg drug res9: lipid_lowering_other 5811001 2120300 Fibrates
1217 CPRD_product_code LIPANTIL MICRO 200 capsules 200mg [FOURNIER] drug res9: lipid_lowering_other 5810002 2120300 Fibrates
12211 CPRD_product_code nicotinic acid tablets 50mg drug res9: lipid_lowering_other 1933002 2120500 Nicotinic acid group
1324 CPRD_product_code BEZALIP tablets 200mg [ROCHE] drug res9: lipid_lowering_other 2104001 2120300 Fibrates
14379 CPRD_product_code LIPANTIL MICRO capsules 67mg [ABBOTT] drug res9: lipid_lowering_other 11702001 2120300 Fibrates
14963 CPRD_product_code nicotinic acid modified release tablet 500mg drug res9: lipid_lowering_other 12144001 2120500 Nicotinic acid group
1716 CPRD_product_code QUESTRAN sachets 4g [BRISTOL] drug res9: lipid_lowering_other 802001 01090200/02120100 Bile acid sequestrants/Bile acid sequestrants (lipid-regulating drugs)
17614 CPRD_product_code ZIMBACOL XL modified release tablet 400mg [ARCHIMEDES] drug res9: lipid_lowering_other 10910001 2120300 Fibrates
1764 CPRD_product_code QUESTRAN LIGHT sachets 4g [BRISTOL] drug res9: lipid_lowering_other 6457001 01090200/02120100 Bile acid sequestrants/Bile acid sequestrants (lipid-regulating drugs)
17813 CPRD_product_code nicotinic acid tablets 100mg drug res9: lipid_lowering_other 1933003 2120500 Nicotinic acid group
17824 CPRD_product_code nicotinic acid tablets 25mg drug res9: lipid_lowering_other 1933001 2120500 Nicotinic acid group
18081 CPRD_product_code COLESTID ORANGE granules [PHARMACIA] drug res9: lipid_lowering_other 12239001 2120100 Bile acid sequestrants (lipid-regulating drugs)
18098 CPRD_product_code nicotinic acid modified release tablet 375mg + 500mg + 750mg drug res9: lipid_lowering_other 12150001 2120500 Nicotinic acid group
18126 CPRD_product_code nicotinic acid modified release tablet 1000mg drug res9: lipid_lowering_other 12146001 2120500 Nicotinic acid group
184 CPRD_product_code bezafibrate tablets 200mg drug res9: lipid_lowering_other 4047001 2120300 Fibrates
19938 CPRD_product_code colestipol with aspartame granules drug res9: lipid_lowering_other 5394001 2120100 Bile acid sequestrants (lipid-regulating drugs)
2215 CPRD_product_code LOPID capsules 300mg [PFIZER] drug res9: lipid_lowering_other 2752001 2120300 Fibrates
23153 CPRD_product_code LIPAROL XL modified release tablet 400mg [ASHBOURNE] drug res9: lipid_lowering_other 4194001 2120300 Fibrates
23956 CPRD_product_code MAXEPA emulsion [SEVEN SEAS] drug res9: lipid_lowering_other 2921003 2120600 Omega-3 preparations
24084 CPRD_product_code COLESTYRAMINE sachets 4g [PLIVA] drug res9: lipid_lowering_other 4152009 01090200/02120100 Bile acid sequestrants/Bile acid sequestrants (lipid-regulating drugs)
2435 CPRD_product_code LIPANTIL capsules 100mg [FOURNIER] drug res9: lipid_lowering_other 5810001 2120300 Fibrates
24583 CPRD_product_code nicotinic acid modified release tablet 750mg drug res9: lipid_lowering_other 12145001 2120500 Nicotinic acid group
2662 CPRD_product_code MAXEPA capsules 1g [SEVEN SEAS] drug res9: lipid_lowering_other 2921001 2120600 Omega-3 preparations
29213 CPRD_product_code BEZAGEN XL modified release tablet 400mg [GEN (UK)] drug res9: lipid_lowering_other 10598001 2120300 Fibrates
29328 CPRD_product_code BEZAFIBRATE tablets 200mg [HILLCROSS] drug res9: lipid_lowering_other 3314010 2120300 Fibrates
3089 CPRD_product_code ciprofibrate tablets 100mg drug res9: lipid_lowering_other 2276001 2120300 Fibrates
31221 CPRD_product_code BEZAFIBRATE tablets 200mg [GEN (UK)] drug res9: lipid_lowering_other 3343009 2120300 Fibrates
3159 CPRD_product_code fenofibrate capsules 200mg drug res9: lipid_lowering_other 5811002 2120300 Fibrates
31783 CPRD_product_code FENOGAL capsules 200mg [GENUS] drug res9: lipid_lowering_other 9350001 2120300 Fibrates
3204 CPRD_product_code MAXEPA liquid [SEVEN SEAS] drug res9: lipid_lowering_other 2921002 2120600 Omega-3 preparations
32110 CPRD_product_code COLESTYRAMINE sachets 4g [DOMINION] drug res9: lipid_lowering_other 2344009 01090200/02120100 Bile acid sequestrants/Bile acid sequestrants (lipid-regulating drugs)
3318 CPRD_product_code gemfibrozil capsules 300mg drug res9: lipid_lowering_other 3704001 2120300 Fibrates
33603 CPRD_product_code FIBRAZATE XL tablets 400mg [SANDOZ] drug res9: lipid_lowering_other 12974001 2120300 Fibrates
33944 CPRD_product_code BEZAFIBRATE tablets 200mg [TEVA] drug res9: lipid_lowering_other 6161009 2120300 Fibrates
34181 CPRD_product_code BEZAFIBRATE modified release tablet 400mg [HILLCROSS] drug res9: lipid_lowering_other 3314009 2120300 Fibrates
34201 CPRD_product_code COLESTYRAMINE sachets 4g [ACTAVIS] drug res9: lipid_lowering_other 3865009 01090200/02120100 Bile acid sequestrants/Bile acid sequestrants (lipid-regulating drugs)
34277 CPRD_product_code GEMFIBROZIL tablets 600mg [TEVA] drug res9: lipid_lowering_other 2191010 2120300 Fibrates
37266 CPRD_product_code colesevelam hydrochloride tablets 625mg drug res9: lipid_lowering_other 15731001 2120100 Bile acid sequestrants (lipid-regulating drugs)
37953 CPRD_product_code CHOLESTAGEL tablets 625mg [GENZYME] drug res9: lipid_lowering_other 15732001 2120100 Bile acid sequestrants (lipid-regulating drugs)
39420 CPRD_product_code BEZALIP MONO modified release tablet 400mg [ACTAVIS] drug res9: lipid_lowering_other 16812001 2120300 Fibrates
39576 CPRD_product_code BEZALIP tablets 200mg [ACTAVIS] drug res9: lipid_lowering_other 16811001 2120300 Fibrates
4062 CPRD_product_code LOPID tablets 600mg [PFIZER] drug res9: lipid_lowering_other 2752002 2120300 Fibrates
4067 CPRD_product_code OLBETAM capsules 250mg [PHARMACIA] drug res9: lipid_lowering_other 5117001 2120500 Nicotinic acid group
40729 CPRD_product_code TREDAPTIVE modified release tablet 1g + 20mg [M S D] drug res9: lipid_lowering_other 17344001 2120500 Nicotinic acid group
40885 CPRD_product_code nicotinic acid with laropiprant modified release tablet 1g + 20mg drug res9: lipid_lowering_other 16405001 2120500 Nicotinic acid group
41396 CPRD_product_code FENOFIBRATE MICRO capsules 200mg [HILLCROSS] drug res9: lipid_lowering_other 3978009 2120300 Fibrates
42801 CPRD_product_code BEZAFIBRATE XL modified release tablet 400mg [GEN (UK)] drug res9: lipid_lowering_other 3363009 2120300 Fibrates
47935 CPRD_product_code FENOFIBRATE capsules 200mg [TEVA] drug res9: lipid_lowering_other 7876009 2120300 Fibrates
4920 CPRD_product_code fenofibrate micronised capsules 200mg drug res9: lipid_lowering_other 11701003 2120300 Fibrates
4928 CPRD_product_code LIPANTIL MICRO capsules 200mg [ABBOTT] drug res9: lipid_lowering_other 11702002 2120300 Fibrates
5216 CPRD_product_code BEZALIP MONO modified release tablet 400mg [ROCHE] drug res9: lipid_lowering_other 985001 2120300 Fibrates
5390 CPRD_product_code fenofibrate micronised capsules 267mg drug res9: lipid_lowering_other 11701002 2120300 Fibrates
5564 CPRD_product_code COLESTID orange sachets [PHARMACIA] drug res9: lipid_lowering_other 5338002 2120100 Bile acid sequestrants (lipid-regulating drugs)
602 CPRD_product_code bezafibrate modified release tablet 400mg drug res9: lipid_lowering_other 4047002 2120300 Fibrates
6120 CPRD_product_code EZETROL tablets 10mg [M S D] drug res9: lipid_lowering_other 7706001 2120200 Ezetimibe
6155 CPRD_product_code colestyramine with aspartame powder sugar-free 4g drug res9: lipid_lowering_other 9346001 01090200/02120100 Bile acid sequestrants/Bile acid sequestrants (lipid-regulating drugs)
6365 CPRD_product_code COLESTID granules [PHARMACIA] drug res9: lipid_lowering_other 5338001 2120100 Bile acid sequestrants (lipid-regulating drugs)
644 CPRD_product_code colestyramine powder 4g drug res9: lipid_lowering_other 3321001 01090200/02120100 Bile acid sequestrants/Bile acid sequestrants (lipid-regulating drugs)
653 CPRD_product_code ezetimibe tablets 10mg drug res9: lipid_lowering_other 7707001 2120200 Ezetimibe
6572 CPRD_product_code OMACOR capsules [ABBOTT] drug res9: lipid_lowering_other 10199001 2120600 Omega-3 preparations
7540 CPRD_product_code LIPANTIL MICRO capsules 267mg [ABBOTT] drug res9: lipid_lowering_other 11702003 2120300 Fibrates
7544 CPRD_product_code NIASPAN modified release tablet 750mg [ABBOTT] drug res9: lipid_lowering_other 12148001 2120500 Nicotinic acid group
7551 CPRD_product_code NIASPAN modified release tablet 1000mg [ABBOTT] drug res9: lipid_lowering_other 12149001 2120500 Nicotinic acid group
8082 CPRD_product_code gemfibrozil tablets 600mg drug res9: lipid_lowering_other 3704002 2120300 Fibrates
8104 CPRD_product_code acipimox capsules 250mg drug res9: lipid_lowering_other 5116001 2120500 Nicotinic acid group
8366 CPRD_product_code probucol tablets 250mg drug res9: lipid_lowering_other 4598001 2120700 Other lipid-regulating drugs
8706 CPRD_product_code MODALIM tablets 100mg [SANOFI/AVE] drug res9: lipid_lowering_other 2248001 2120300 Fibrates
8834 CPRD_product_code LURSELLE tablets 250mg [HOECHSTMAR] drug res9: lipid_lowering_other 543001 2120700 Other lipid-regulating drugs
9491 CPRD_product_code fenofibrate micronised capsules 67mg drug res9: lipid_lowering_other 11701001 2120300 Fibrates
9639 CPRD_product_code fenofibrate micronised tablets 160mg drug res9: lipid_lowering_other 7539001 2120300 Fibrates
9716 CPRD_product_code SUPRALIP tablets 160mg [ABBOTT] drug res9: lipid_lowering_other 5200001 2120300 Fibrates

1 comment has been posted.

June 22, 2015, 5:31 a.m. - David Springate

Non-statin lipid-lowering medicines

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