Legacy benefits of blood glucose, blood pressure and lipid control in individuals with diabetes and cardiovascular disease: Time to overcome multifactorial therapeutic inertia?

Diabetes Obes Metab. 2018 Jun;20(6):1337-1341. doi: 10.1111/dom.13243. Epub 2018 Mar 11.

Abstract

Cardiovascular disease is a major cause of morbidity and mortality globally and the largest contributor to healthcare costs. There is good evidence that management of risk factors such as blood pressure, dyslipidaemia and glucose can lead to improved microvascular and macrovascular complications in individuals with type 2 diabetes mellitus. Legacy effect is a phenomenon used to describe the prolonged benefits of glucose, blood pressure or lipid control in individuals with cardiovascular disease, diabetes or in primary prevention of cardiovascular disease by early risk factor control. There is now also good quality evidence on the legacy benefits of multifactorial risk factor interventions on renal, cardiovascular and mortality outcomes. Despite this robust evidence, therapeutic inertia is widespread in the management of these risk factors in clinical practice.

Keywords: blood pressure; glycaemic control; legacy effect; lipids.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / prevention & control*
  • Combined Modality Therapy
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / mortality
  • Diabetes Mellitus, Type 1 / therapy
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / mortality
  • Diabetes Mellitus, Type 2 / therapy
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / mortality
  • Diabetic Angiopathies / prevention & control
  • Diabetic Angiopathies / therapy
  • Diabetic Cardiomyopathies / epidemiology
  • Diabetic Cardiomyopathies / mortality
  • Diabetic Cardiomyopathies / prevention & control*
  • Dyslipidemias / blood
  • Dyslipidemias / complications
  • Dyslipidemias / mortality
  • Dyslipidemias / therapy
  • Evidence-Based Medicine*
  • Humans
  • Hyperglycemia / prevention & control
  • Hypertension / complications
  • Hypertension / mortality
  • Hypertension / therapy
  • Hypoglycemia / prevention & control
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'*
  • Risk Factors