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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: statins

105 codes in list

Code Coding system Description Entity type List name multilexcode bnfcode bnfchapter
11627 CPRD_product_code fluvastatin 24 hour modified release tablets 80mg drug res9: statins 7195003 2120400 Statins
1219 CPRD_product_code pravastatin tablets 40mg drug res9: statins 6755003 2120400 Statins
1221 CPRD_product_code LIPOSTAT tablets 10mg [SQUIBB] drug res9: statins 6756001 2120400 Statins
1223 CPRD_product_code LIPOSTAT tablets 40mg [SQUIBB] drug res9: statins 6756003 2120400 Statins
13041 CPRD_product_code SIMVADOR tablets 10mg [DISCOVERY] drug res9: statins 12081001 2120400 Statins
15252 CPRD_product_code CRESTOR tablets 20mg [ASTRAZENEC] drug res9: statins 7591001 2120400 Statins
17683 CPRD_product_code LIPITOR tablets 80mg [PFIZER] drug res9: statins 9690001 2120400 Statins
17688 CPRD_product_code CRESTOR tablets 5mg [ASTRAZENEC] drug res9: statins 13532001 2120400 Statins
18442 CPRD_product_code LIPOBAY tablets 400micrograms [BAYER] drug res9: statins 7552001 2120400 Statins
2137 CPRD_product_code fluvastatin capsules 40mg drug res9: statins 7195002 2120400 Statins
22579 CPRD_product_code ZOCOR tablets 80mg [M S D] drug res9: statins 7528001 2120400 Statins
25 CPRD_product_code simvastatin tablets 20mg drug res9: statins 6380002 2120400 Statins
2718 CPRD_product_code ZOCOR tablets 10mg [M S D] drug res9: statins 6379001 2120400 Statins
28 CPRD_product_code atorvastatin tablets 10mg drug res9: statins 10688001 2120400 Statins
2955 CPRD_product_code LIPITOR tablets 40mg [PFIZER] drug res9: statins 10693003 2120400 Statins
31658 CPRD_product_code cerivastatin tablets 800micrograms drug res9: statins 7551002 2120400 Statins
31930 CPRD_product_code ZOCOR HEART-PRO tablets 10mg [MCNEIL] drug res9: statins 12626001 2120400 Statins
32909 CPRD_product_code SIMVASTATIN tablets 80mg [HILLCROSS] drug res9: statins 4499009 2120400 Statins
32921 CPRD_product_code PRAVASTATIN tablets 10mg [DR REDDY`S] drug res9: statins 5605009 2120400 Statins
33082 CPRD_product_code SIMVASTATIN tablets 20mg [HILLCROSS] drug res9: statins 4497009 2120400 Statins
3411 CPRD_product_code LIPITOR tablets 10mg [PFIZER] drug res9: statins 10693001 2120400 Statins
34312 CPRD_product_code SIMVASTATIN tablets 20mg [GEN (UK)] drug res9: statins 4549009 2120400 Statins
34316 CPRD_product_code SIMVASTATIN tablets 20mg [TEVA] drug res9: statins 4505009 2120400 Statins
34353 CPRD_product_code SIMVASTATIN tablets 40mg [GEN (UK)] drug res9: statins 4550009 2120400 Statins
34366 CPRD_product_code SIMVASTATIN tablets 20mg [IVAX] drug res9: statins 4517009 2120400 Statins
34376 CPRD_product_code SIMVASTATIN tablets 40mg [TEVA] drug res9: statins 4506009 2120400 Statins
34381 CPRD_product_code SIMVASTATIN tablets 40mg [IVAX] drug res9: statins 4518009 2120400 Statins
34476 CPRD_product_code SIMVASTATIN tablets 20mg [RATIOPHARM] drug res9: statins 4449009 2120400 Statins
34481 CPRD_product_code SIMVASTATIN tablets 10mg [IVAX] drug res9: statins 4516009 2120400 Statins
34502 CPRD_product_code SIMVASTATIN tablets 40mg [HILLCROSS] drug res9: statins 4498009 2120400 Statins
34535 CPRD_product_code SIMVASTATIN tablets 10mg [GEN (UK)] drug res9: statins 4548009 2120400 Statins
34545 CPRD_product_code SIMVASTATIN tablets 40mg [RATIOPHARM] drug res9: statins 4450009 2120400 Statins
34560 CPRD_product_code SIMVASTATIN tablets 10mg [RATIOPHARM] drug res9: statins 4448009 2120400 Statins
34746 CPRD_product_code SIMVASTATIN tablets 20mg [NICHE] drug res9: statins 4524009 2120400 Statins
34814 CPRD_product_code SIMVASTATIN tablets 20mg [WOCKHARDT] drug res9: statins 4512009 2120400 Statins
34820 CPRD_product_code PRAVASTATIN tablets 40mg [HILLCROSS] drug res9: statins 5150009 2120400 Statins
34879 CPRD_product_code SIMVASTATIN tablets 40mg [NICHE] drug res9: statins 4525009 2120400 Statins
34891 CPRD_product_code SIMVASTATIN tablets 20mg [KENT] drug res9: statins 4527009 2120400 Statins
34907 CPRD_product_code SIMVASTATIN tablets 40mg [WOCKHARDT] drug res9: statins 4513009 2120400 Statins
34955 CPRD_product_code SIMVASTATIN tablets 10mg [HILLCROSS] drug res9: statins 4491009 2120400 Statins
34969 CPRD_product_code SIMVASTATIN tablets 40mg [ACTAVIS] drug res9: statins 4521009 2120400 Statins
36377 CPRD_product_code PRAVASTATIN tablets 20mg [TEVA] drug res9: statins 5169009 2120400 Statins
3690 CPRD_product_code LIPOSTAT tablets 20mg [SQUIBB] drug res9: statins 6756002 2120400 Statins
37434 CPRD_product_code SIMVASTATIN tablets 40mg [SANDOZ] drug res9: statins 4594009 2120400 Statins
379 CPRD_product_code fluvastatin capsules 20mg drug res9: statins 7195001 2120400 Statins
39060 CPRD_product_code SIMVASTATIN tablets 20mg [DEXCEL] drug res9: statins 4721009 2120400 Statins
39652 CPRD_product_code simvastatin oral suspension sugar-free 40mg/5ml drug res9: statins 16900001 2120400 Statins
39675 CPRD_product_code SIMVASTATIN oral suspension 20mg/5ml [MARTINDALE] drug res9: statins 6495009 2120400 Statins
39870 CPRD_product_code SIMVADOR tablets 80mg [DISCOVERY] drug res9: statins 16969001 2120400 Statins
40340 CPRD_product_code SIMVASTATIN tablets 10mg [TEVA] drug res9: statins 4504009 2120400 Statins
40382 CPRD_product_code PRAVASTATIN tablets 20mg [HILLCROSS] drug res9: statins 5149009 2120400 Statins
40601 CPRD_product_code SIMVASTATIN tablets 20mg [RANBAXY] drug res9: statins 5592009 2120400 Statins
41657 CPRD_product_code SIMVASTATIN tablets 80mg [TEVA] drug res9: statins 4814009 2120400 Statins
42 CPRD_product_code simvastatin tablets 10mg drug res9: statins 6380001 2120400 Statins
420 CPRD_product_code cerivastatin tablets 100micrograms drug res9: statins 10845001 2120400 Statins
43218 CPRD_product_code PRAVASTATIN tablets 10mg [TEVA] drug res9: statins 5168009 2120400 Statins
44528 CPRD_product_code SIMVASTATIN oral suspension sugar-free 20mg/5ml [ROSEMONT] drug res9: statins 7845009 2120400 Statins
44650 CPRD_product_code SIMVASTATIN tablets 40mg [DEXCEL] drug res9: statins 4722009 2120400 Statins
44878 CPRD_product_code RANZOLONT tablets 10mg [RANBAXY] drug res9: statins 12581001 2120400 Statins
45219 CPRD_product_code SIMVASTATIN tablets 40mg [KENT] drug res9: statins 4528009 2120400 Statins
45235 CPRD_product_code SIMVASTATIN tablets 20mg [SANDOZ] drug res9: statins 4593009 2120400 Statins
45245 CPRD_product_code SIMVASTATIN tablets 20mg [ACTAVIS] drug res9: statins 4520009 2120400 Statins
45346 CPRD_product_code SIMVASTATIN tablets 40mg [ARROW] drug res9: statins 4556009 2120400 Statins
46878 CPRD_product_code SIMVASTATIN tablets 40mg [ALMUS] drug res9: statins 6128009 2120400 Statins
46956 CPRD_product_code SIMVASTATIN tablets 80mg [ARROW] drug res9: statins 4557009 2120400 Statins
47065 CPRD_product_code atorvastatin chewable tablet 20mg drug res9: statins 18950001 2120400 Statins
47090 CPRD_product_code atorvastatin chewable tablet 10mg drug res9: statins 18948001 2120400 Statins
47630 CPRD_product_code LIPITOR chewable tablet 20mg [PFIZER] drug res9: statins 18951001 2120400 Statins
47721 CPRD_product_code LIPITOR chewable tablet 10mg [PFIZER] drug res9: statins 18949001 2120400 Statins
47774 CPRD_product_code SIMVASTATIN tablets 10mg [ARROW] drug res9: statins 4554009 2120400 Statins
47948 CPRD_product_code SIMVASTATIN tablets 10mg [TILLOMED] drug res9: statins 4625009 2120400 Statins
47988 CPRD_product_code PRAVASTATIN tablets 40mg [GEN (UK)] drug res9: statins 5297009 2120400 Statins
48018 CPRD_product_code SIMVASTATIN tablets 20mg [ARROW] drug res9: statins 4555009 2120400 Statins
48051 CPRD_product_code SIMVASTATIN tablets 10mg [KENT] drug res9: statins 4526009 2120400 Statins
48058 CPRD_product_code SIMVASTATIN tablets 10mg [RANBAXY] drug res9: statins 5591009 2120400 Statins
48078 CPRD_product_code SIMVASTATIN tablets 10mg [ACTAVIS] drug res9: statins 4519009 2120400 Statins
48097 CPRD_product_code PRAVASTATIN tablets 40mg [TEVA] drug res9: statins 5170009 2120400 Statins
490 CPRD_product_code pravastatin tablets 10mg drug res9: statins 6755001 2120400 Statins
4961 CPRD_product_code LIPOBAY tablets 300micrograms [BAYER] drug res9: statins 10846003 2120400 Statins
5009 CPRD_product_code cerivastatin tablets 200micrograms drug res9: statins 10845002 2120400 Statins
51 CPRD_product_code simvastatin tablets 40mg drug res9: statins 6380003 2120400 Statins
5148 CPRD_product_code simvastatin tablets 80mg drug res9: statins 7779001 2120400 Statins
5251 CPRD_product_code cerivastatin tablets 300micrograms drug res9: statins 10845003 2120400 Statins
5278 CPRD_product_code cerivastatin tablets 400micrograms drug res9: statins 7551001 2120400 Statins
5775 CPRD_product_code atorvastatin tablets 80mg drug res9: statins 9689001 2120400 Statins
5985 CPRD_product_code LESCOL XL tablets 80mg [NOVARTIS] drug res9: statins 8805001 2120400 Statins
6168 CPRD_product_code ZOCOR tablets 40mg [M S D] drug res9: statins 6379003 2120400 Statins
6213 CPRD_product_code rosuvastatin tablets 20mg drug res9: statins 9026001 2120400 Statins
713 CPRD_product_code rosuvastatin tablets 10mg drug res9: statins 11465001 2120400 Statins
7196 CPRD_product_code ZOCOR tablets 20mg [M S D] drug res9: statins 6379002 2120400 Statins
730 CPRD_product_code pravastatin tablets 20mg drug res9: statins 6755002 2120400 Statins
7347 CPRD_product_code CRESTOR tablets 10mg [ASTRAZENEC] drug res9: statins 7590001 2120400 Statins
7374 CPRD_product_code LIPITOR tablets 20mg [PFIZER] drug res9: statins 10693002 2120400 Statins
745 CPRD_product_code atorvastatin tablets 40mg drug res9: statins 10688003 2120400 Statins
75 CPRD_product_code atorvastatin tablets 20mg drug res9: statins 10688002 2120400 Statins
7554 CPRD_product_code rosuvastatin tablets 5mg drug res9: statins 13531001 2120400 Statins
802 CPRD_product_code SIMVADOR tablets 40mg [DISCOVERY] drug res9: statins 12083001 2120400 Statins
818 CPRD_product_code simvastatin oral suspension sugar-free 20mg/5ml drug res9: statins 13979001 2120400 Statins
8380 CPRD_product_code LESCOL capsules 20mg [NOV/SANDOZ] drug res9: statins 7194001 2120400 Statins
9153 CPRD_product_code LESCOL capsules 40mg [NOV/SANDOZ] drug res9: statins 7194002 2120400 Statins
9315 CPRD_product_code LIPOBAY tablets 100micrograms [BAYER] drug res9: statins 10846001 2120400 Statins
9316 CPRD_product_code LIPOBAY tablets 200micrograms [BAYER] drug res9: statins 10846002 2120400 Statins
9897 CPRD_product_code rosuvastatin tablets 40mg drug res9: statins 7589001 2120400 Statins
9920 CPRD_product_code SIMVADOR tablets 20mg [DISCOVERY] drug res9: statins 12082001 2120400 Statins
9930 CPRD_product_code CRESTOR tablets 40mg [ASTRAZENEC] drug res9: statins 7460001 2120400 Statins

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