CHD risk needs separating by glycemic status

By Sally Robertson, B.Sc.Jul 23 2012

People with diabetes not only have a higher incidence of coronary heart disease (CHD) events compared with people without diabetes, but they differ in the type of risk factors they have for such events, report US researchers.

"These differences must be recognized in estimating CHD risk and managing risk factors," say Jiaqiong Xu (The Methodist Hospital Research Institute, Houston, Texas) and colleagues.

In an analysis of American Indian participants from the Strong Heart Study (SHS), the team found that 545 and 216 CHD events occurred in 1872 of those with diabetes and 1691 without diabetes, respectively, between 1989 and 1999.

Age- and gender-adjusted incidence rates of CHD were significantly higher among individuals who had diabetes than they were among those without the condition, at 27.5 versus 12.1 for each 1,000 person-years of follow-up.

Multivariate analysis revealed that some significant risk factors for CHD were common to both diabetic and nondiabetic individuals, namely, older age, male gender, prehypertension or hypertension, and elevated low-density lipoprotein cholesterol.

However, some risk factors were specific only to those who had diabetes and included lower high-density lipoprotein cholesterol, current smoking, macroalbuminuria, lower estimated glomerular filtration rate, use of diabetic medication, and longer duration of diabetes.

Higher body mass index, on the other hand was an independent determinant of CHD only in those without diabetes.

"This is the first study comparing incidence rates and risk factors for CHD in nondiabetic vs diabetic persons in a single population with high prevalence of diabetes," write the researchers in the Journal of Clinical Endocrinology and Metabolism.

The team says the findings suggest that equations estimating CHD risk should be developed separately for those with and without diabetes.

"Risk factor management programs should recognize the enhanced potential for CHD in obese persons, even in those without diabetes, and should focus on management of BP and LDL cholesterol," concludes the team.

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