Declining Coronary Heart Disease Risk among Diabetes Patients

An official from the U.S. Centers for Disease Control and Prevention told Reuters Health that doctors should be pleased with themselves. "(They) should be encouraged that the trends for HbA1c, blood pressure, and the lipid ratio are moving in the desired direction," Dr. Earl S. Ford told Reuters Health in an email. "Much of this progress is likely attributable to the efforts of physicians in getting more patients on treatment."

Using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2008, Dr. Ford looked for trends in the 10-year risk for CHD among 1,977 adults with diabetes in the United States.

He reported online April 19th in Diabetes Care that he saw declining trends in hemoglobin (Hb)A1c concentration, mean systolic blood pressure, total cholesterol, and the ratio of total cholesterol to HDL cholesterol.

The estimated 10-year risk for coronary disease fell significantly between 1999-2000 and 2007-2008, whether using the UK Prospective Diabetes Study (UKPDS) Risk Engine (from 21.1% to 16.4%) or risk equations from the Atherosclerosis Risk In Communities (ARIC) study (from 18.7% to 15.9%), or the Framingham Heart Study (from 18.6% to 14.6%).

With UKPDS, there were significant decreases in the risk for CHD among men and women and among whites, African Americans, and Mexican Americans.

In contrast, ARIC risk estimates declined significantly for whites and Mexican Americans but not for African Americans, and Framingham risk estimates showed significant decreases for whites and African Americans but only a favorable trend for Mexican Americans.

"Because the most recent data did not indicate that the decrease in the estimated risk for coronary heart disease from 1999-2000 to 2005-2006 continued into 2007-2008, future monitoring will be essential to determine whether this possible interruption in the trend is a temporary phenomenon that may represent sampling variation or represents a real change in the direction of the trend," Dr. Ford explains in his report.

Dr. Ford stated that, "The fact that concentrations of HbA1c, blood pressure, and the lipid ratio improved over time when the prevalence of obesity was possibly increasing among people with diabetes is interesting in its own right and suggests that even further progress in risk factor control might have been achievable." "It should be noted, however, that information about the temporal trends in obesity among people with diabetes remains unclear. The national data about obesity in the general population suggest that the prevalence of obesity may be leveling off in some segments of the population."

"Because lifestyle behaviors profoundly influence many of the risk factors for cardiovascular disease, physicians who are successful in assisting patients to improve key lifestyle behaviors of their patients -- smoking, diet, and physical activity -- will make important contributions to the cardiovascular health of their patients," Dr. Ford concluded.