Maintenance of cardiovascular risk goals in veterans with diabetes after discharge from a cardiovascular risk reduction clinic

The authors evaluated maintenance of achieved cardiovascular risk control after discharge from a pharmacist-coordinated cardiovascular risk reduction clinic. Using data from 2001 to 2004 divided by financial quarters (ie, 3-month periods), the authors performed survival analysis of diabetic patients who had attained at least one cardiovascular risk goal in the clinic. Mean times to failure were 7.1±0.21 quarters for hemoglobin A1c, 7.6±0.29 quarters for low-density lipoprotein cholesterol (LDL-C), and 2.5±0.24 quarters for systolic blood pressure (SBP). Body mass index predicted glycemic control failure (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.01-1.15; P=.02), insulin use predicted LDL-C control failure (HR, 3.08; 95% CI, 1.15-8.22; P=.03), and baseline SBP predicted SBP control failure (HR, 1.02; 95% CI, 1.01-1.03; P=.0003). The authors found good durability of effect for most cardiovascular risk targets. Worse control at entry predicted failure after successful attainment of a cardiovascular goal. More sustained attention or booster interventions for patients with worse control at entry may be necessary. © 2009 Wiley Periodicals, Inc