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Is Diabetes Truly a Coronary Heart Disease Risk Equivalent?

A new literature review suggests that not all diabetic patients are at equal risk for coronary heart disease…. 

The National Cholesterol Education Programme Adult Treatment Panel III (NCEP-ATPIII) has stressed the importance of diabetes as a high risk condition for cardiovascular disease. They consider diabetes to be a coronary heart disease risk equivalent. By this definition, the cardiovascular event risk in patients with diabetes but without coronary heart disease is as high as the cardiovascular event risk in patients with coronary heart disease but without diabetes.

For patients, concluding they have a coronary heart disease risk equivalent confers to therapeutic, psychological and economic consequences. With designation as a risk equivalent, therapeutic goals become a clinical significance. Whether following European Society of Cardiology/European Atherosclerosis Society stringent LDL cholesterol goal of < 70 mg/dL or current ADA recommendations, patients generally require the effectiveness of statin therapy and monitoring. Psychological discomfort remains in classifying diabetes patients as coronary heart disease risk equivalent giving them a worse prognosis than they actually have.

In order to determine whether diabetes is a coronary heart disease risk equivalent, Christoph H. Saely and colleagues conducted a detailed review of literature. Several reports were found to support the concept of diabetes as the risk equivalent while other investigative research has refuted the designation of the term. Select reports found the correlation only to be associated with gender as seen by the increase in cardiovascular risk of diabetic women. Other factors the authors found to be indicative of the cardiovascular risk included the duration of diabetes, affiliated risk factors, and presence of subclinical atherosclerosis.

Saely concluded, "That the concept of diabetes as a CHD risk equivalent is overly simplistic, because not all patients with diabetes are at the same cardiovascular risk. An individualized approach to cardiovascular risk estimation and management appears mandatory in patients with diabetes."

Christoph H. Saely, Heinz Drexel. "Is type 2 diabetes really a coronary heart disease risk equivalent?" Vascular Pharmacology. 20 May 2013 http://dx.doi.org/10.1016/j.vph.2013.05.003