#98 Is Diabetes a Coronary Heart Disease Equivalent?
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- Compared with patients with previous MI, diabetic patients have half the risk of CHD.
- Odds ratio 0.56 (95% confidence interval 0.53-0.60).
- After adjusting for some cardiac risk factors, socioeconomic status, and CV drugs:
- Diabetics had lower risk of MI or coronary death (hazard ratio 0.63 in men and 0.54 in women) than patients with prior MI.
- Limitations: No adjustment for most traditional risk factors (blood pressure, smoking status, etc.), which would have likely attenuated the association in diabetics further.
- Diabetes: 1.70 (1.66-1.74);
- Diabetes duration >10 years: 2.7 (2.6-2.8);
- Prior CHD: 2.76 (2.69-2.85);
- Both diabetes and prior CHD: 3.91 (3.78-4.05).
- North American guidelines4,5 no longer equate diabetes to existing CHD.
- Canadian cholesterol guidelines4 classify diabetics with ≥1 of the following as high-risk patients who may benefit from a statin:
- Age ≥40 years;
- Age ≥30 years and duration of diabetes >15 years; or
- Microvascular disease (nephropathy, neuropathy, retinopathy).
- The observational study6 that originally generated the concept of diabetes-CHD equivalence had multiple limitations, including selection bias and being very underpowered.
- Presence of diabetes approximately doubles the risk of CV events:3,7
- Associated risk further increased by longer duration of diabetes,3,8 increasing HbA1c,9 and traditional cardiac risk factors.10
- Most studies were completed in Caucasians, and the applicability of this evidence to high-risk ethnic populations is unclear.