Legacy benefits of blood glucose, blood pressure and lipid control in individuals with diabetes and cardiovascular disease: Time to overcome multifactorial therapeutic inertia?
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.
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Addressing multiple cardiovascular risk factors (glycemic, blood pressure, and lipid management) simultaneously produces large benefits, with evidence for long-lasting benefits.
“Furthermore, large benefits are seen when multiple cardiovascular risk factors (glycemic, blood pressure, and lipid management) are addressed simultaneously, with evidence for long-lasting benefits (3)(4)(5).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [5]
Large benefits are seen when multiple cardiovascular risk factors (glycemic, blood pressure, and lipid management) are addressed simultaneously, with evidence for long-lasting benefits.
“large benefits are seen when multiple cardiovascular risk factors (glycemic, blood pressure, and lipid management) are addressed simultaneously, with evidence for long-lasting benefits (3–5).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [5]
Managing individual cardiovascular risk factors prevents or slows ASCVD in people with diabetes.
“Numerous studies have shown the efficacy of managing individual cardiovascular risk factors in preventing or slowing ASCVD in people with diabetes.”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [5]
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Self-citation
- Authors
- Khunti, K., Kosiborod, M., & Ray, K. K.
- Affiliations
- University of Leicester (GB)
- Saint Luke's Hospital (US)
- Imperial College London (GB)
- Corresponding author
- Khunti, Kamlesh
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2018-03-11
- Volume
- 20
- Issue
- 6
- Pages
- 1337-1341
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- OpenAlex
- W2794361474
- Cited by
- 104
- References
- 30
- Citations by year
- 2026: 12 · 2025: 15 · 2024: 15 · 2023: 12 · 2022: 10 · 2021: 9 · 2020: 13 · 2019: 15 · 2018: 3
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care - East Midlands (NIHR CLAHRC - EM)
- NIHR Leicester, Biomedical Research Centre
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- legacy effects, therapeutic inertia, type 2 diabetes, cardiovascular disease, glycemic control, blood pressure control, lipid control, microvascular complications, macrovascular complications, renal outcomes, mortality, cardiovascular risk factors
- MeSH terms
- Cardiovascular Diseases, Combined Modality Therapy, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Humans, Hyperglycemia, Hypertension, Hypoglycemia, Practice Patterns, Physicians', Risk Factors, Practice Guidelines as Topic, Evidence-Based Medicine, Dyslipidemias, Diabetic Cardiomyopathies
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