Mortality and cumulative cardiovascular risk factor control in patients with type 2 diabetes: a nationwide population-based cohort study

AIM: Effective control of cardiovascular risk factors reduces mortality among patients with type 2 diabetes (T2D), but most evidence is based on baseline measurements. This study investigated the associations between changes and cumulative control of cardiovascular risk factors over the follow-up period and mortality. METHODS: We analyzed 138,193 participants with T2D aged 35-75 years from the ChinaHEART project. Risk factor control included no current smoking, healthy diet, physical activity, and normal levels of blood pressure, cholesterol, glucose, and BMI. Cumulative control was assessed using time-weighted average (TWA), and Cox models estimated hazard ratios (HRs). Changes in control were evaluated by comparing the number of risk factors controlled at baseline and the second follow-up. RESULTS: Over a median follow-up period of 5.6 years, 9,698 deaths occurred (4,475 from CVD). Compared with participants with 0-2 risk factors controlled, those with 3 and 6-7 factors controlled had lower risks of all-cause mortality [HRs: 0.77 (95% CI: 0.73-0.81) and 0.43 (0.38-0.48), respectively]. Improved control was associated with reduced mortality [HR: 0.86 (0.77-0.96)] compared to stable low control, whereas degraded control increased mortality risk by 23% compared to stable high control. Participants in the highest quartile of TWA risk factor control had 47% lower mortality [HR: 0.53 (0.47-0.60)] than those in the lowest quartile. Similar associations were observed for CVD mortality. CONCLUSIONS: Sustained and cumulative cardiovascular risk factor control substantially lowers mortality among patients with T2D, underscoring the critical importance of continuous risk factor management.