Suboptimal Cardiovascular Risk Management Found in Mexican Adults With Diabetes

Despite rising cardiovascular risk, adults with diagnosed diabetes in Mexico show persistently low rates of comprehensive risk factor control, a study finds.1 National survey data reveal that only 29% of individuals achieved glycemic targets, 23% controlled blood pressure, and fewer than 7% managed low-density lipoprotein cholesterol, underscoring the urgent need for strategies to improve cardiovascular outcomes in this population.

Few adults with diabetes in Mexico achieve combined CVD risk factor control, highlighting gaps in blood pressure, cholesterol, and glycemic management. |Stethoscope Heart_AdobeStock_188239868.jpe

This cross-sectional analysis is published in the Journal of the American Heart Association.

“To our knowledge, this is the first study to evaluate the comprehensive CVD [cardiovascular disease] risk management of diabetes in Mexico, whereas most have focused primarily on prevalence and glycemic control,” wrote the researchers of the study. “The use of a series of nationally representative surveys allowed to obtain population‐level estimates of diabetes control, and the availability of information since 2016 facilitates describing the most recent population‐level trends.”

Previously, a study found a strong link between social disadvantage and diabetes phenotypes in Mexico.2 Using nationally representative surveys from 2016 to 2022, researchers found that adults facing greater socioeconomic challenges, such as lower education, higher marginalization, and speaking an indigenous language, were more likely to have severe insulin‑deficient diabetes (SIDD), a subgroup associated with worse clinical outcomes.

In the current study, researchers analyzed data from adults aged 20 years and older with diagnosed diabetes who participated in the 2016, 2018, 2020, and 2023 Mexican National Health and Nutrition Surveys.1 CVD risk factor control was assessed using measures of glycemia, blood pressure, low-density lipoprotein cholesterol (LDL-C), and smoking status, as well as achievement of combined risk factor targets.

Medication use, including glucose-lowering, blood pressure-lowering, and cholesterol-lowering therapies, was also evaluated. The prevalence of individual and combined risk factor control was estimated, and determinants of achieving control were explored, accounting for sociodemographic characteristics, education, sex, age, and state-level socioeconomic position. High or very-high CVD risk was estimated using the Systematic Coronary Risk Evaluation 2-Diabetes (SCORE2-DM) algorithm.

Among 2916 survey participants representing approximately 43.2 million adults with diagnosed diabetes in Mexico, glycemic control was achieved by 29.0% (95% CI, 21.0%–38.0%) and blood pressure control by 22.9% (95% CI, 14.0%–31.0%) in 2023, while 89.0% (95% CI, 81.0%–96.0%) were noncurrent smokers.

LDL-C control remained low but improved modestly, rising from 2.8% (95% CI, 1.2%–4.4%) in 2016 to 6.6% (95% CI, 1.9%–11.2%) in 2023, alongside statin use, which increased from 5.5% to 63% over the same period. High or very-high CVD risk, based on SCORE2-DM, increased from 59.8% (95% CI, 52.1%–67.0%) in 2016 to 68.4% (95% CI, 55.6%–78.9%) in 2023, affecting an estimated 5.1 million adults.

Overall, the achievement of combined CVD risk factor control remained low, with a higher likelihood among women, younger adults, college-educated individuals, and residents of states with higher socioeconomic position.

However, the researchers acknowledged some limitations, which include a small sample size in some survey cycles, which may have reduced precision and power to detect trends. Medication type, dose, adherence, and treatment indications were unavailable, and SCORE2-Diabetes has not been validated in the Mexican population. The cross-sectional design also prevented causal inference regarding determinants of risk factor control.

Despite these limitations, the researchers believe the study finds that, despite modest improvements in LDL-C control and statin use, overall management of cardiovascular risk factors among adults with diabetes in Mexico remains suboptimal.

“Our results suggest a need for strategies to improve comprehensive CVD risk factor management in individuals with diabetes beyond glycemic control, which is essential to improve diabetes care and reduce the risk of diabetes‐related mortality and complications in Mexico,” wrote the researchers.

References

1. Ramírez-García D, Perezalonso-Espinosa J, Méndez-Labra PN, et al. Cardiovascular risk management in adults with diagnosed diabetes in Mexico from 2016 to 2023: a retrospective analysis of nationally representative surveys. J Am Heart Assoc. 2026:e044366. doi:10.1161/JAHA.125.044366

2. Antonio‐Villa NE, Bello‐Chavolla OY, Fermín‐Martínez CA, et al. Diabetes subgroups and sociodemographic inequalities in Mexico: a cross‐sectional analysis of nationally representative surveys from 2016 to 2022. Lancet Reg Health Am. 2024;33:100732. doi:10.1016/j.lana.2024.100732