Some cardiac risk factors modifiable in diabetics

NEW YORK (Reuters Health) - In patients with type 2 diabetes, the risk of having a first episode of coronary heart disease (CHD) depends on a number of factors, including sex; age; control of blood sugar (glucose), high cholesterol and small blood vessel (microvascular) disease. And some of these CHD risk factors can be modified by the patient.

Cardiovascular disease is the major cause of illness and death in patients with diabetes, note Dr. Ele Ferrannini, of the University of Pisa School of Medicine, Italy, and colleagues in the current issue of Diabetes Care. They examined the incidence of a first CHD event in 6,032 women and 5,612 men with type 2 diabetics and identified the associated risk factors.

The researchers collected data from a network of hospital-based diabetes clinics for 4 years. CHD events were defined as heart attack, coronary artery bypass surgery, need for angioplasty, and heart-related chest pain (angina).

The investigators recorded a total of 881 of CHD events during follow-up. The incidence was 29 events per year for every 1,000 men and 23 events per year for every 1,000 women. Major CHD events, such as heart attack, heart surgery or need for angiogram, were significantly more common in men than in women, at 13 versus 6, respectively.

Patients with microvascular complications, such as retinal disease, kidney disease or foot ulcers, had a higher incidence of all cardiac events, according to the team.

Results of further analysis revealed that age and duration of diabetes predicted risk for men and women. Additional independent risk factors in men included poor glucose control and treatment for high blood pressure. Higher triglycerides and lower HDL cholesterol levels, along with microvascular complications, were independent risk factors in women.

High levels of cholesterol, blood glucose, blood pressure and cholesterol, Ferrannini and colleagues point out, "are risk factors amenable to more aggressive treatment."

SOURCE: Diabetes Care, May 2007.