For Diabetes: BP, Cholesterol Key v. Heart Disease
Diabetes & Heart Disease Risk: Results
"People who had all three risk factors under control or only blood pressure and LDL under control were about three times less likely to be hospitalized," he says.
Most likely to be hospitalized were those who had none of the risk factors under control or only blood sugar under control, Nichols says.
However, on average, both those hospitalized and those not had the same average blood sugar level, 7.3%.
The link between poor blood pressure and cholesterol control and heart attack or stroke held, Nichols says, even after taking into account pre-existing disease and other factors that might play a role.
The study shows that ''we just didn't see any additional benefit to getting it below 7," says Nichols of the blood sugar.
"To me the take-home message is yes, diabetes is defined by high blood sugar. But that is not the only thing you need to pay attention to."
Diabetes & Heart Disease Risk: Perspective
''We are clearly doing better [in reducing heart attack and stroke] by taking care of blood pressure and cholesterol," says Robert Ratner, MD, chief scientific and medical officer for the American Diabetes Association.
"They have huge impacts on survival and cardiac events," he says, citing research. "That doesn't mean glucose isn't important."
The protective effects of blood sugar control on heart disease take longer to kick in, according to Ratner, ''and probably aren't as apparent as blood pressure and cholesterol [effects]."
Controlling all three risks is important, he says. "If you begin to ignore one, it's going to start having a deleterious effect on cardiovascular disease risk."
"It's a large study, and that is a strength," says Om Ganda, MD, director of the Lipid Clinic at Joslin Diabetes Center and associate professor of medicine at Harvard Medical School.
But he says that the other diseases in the patients studied ''make it impossible to detect the effects of blood sugar control."
''The glucose [control] effect is very slow, compared to cholesterol and blood pressure," Ganda agrees.
To him, the findings stress the importance of early diagnosis, when blood sugar can be addressed right away.
"Once you have established cardiovascular disease or once you have diabetes for a fairly long duration,'' he says,"indeed, glucose control may not be as important as in the early stages of diabetes."
Funding was provided by AstraZeneca, which makes cholesterol-lowering medicine, and Bristol-Myers Squibb, which makes blood pressure-lowering medicine.
Two study co-authors are AstraZeneca employees and shareholders. Nichols controlled the data.