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The treatment of
cardiovascular risk factors in patients with diabetes is controversial, with some
investigators suggesting that such patients should be treated as though they had
established coronary heart disease (CHD).1 To determine whether diabetic
patients who have not had myocardial infarctions (MIs) should be treated as aggressively
for cardiovascular risk factors as diabetic patients who have had MIs, Haffner and
colleagues compared the 7-year incidence of MI (both fatal and nonfatal) among 1,378
nondiabetic subjects with the MI incidence among 1,059 subjects with non-insulin-dependent
diabetes mellitus (NIDDM) in a Finnish population-based study.2 The probability
of death from CHD was estimated among diabetic and nondiabetic subjects, with and without
prior MI. As this slide shows, the probability of death from CHD was highest among
diabetic subjects with prior MI and was lowest among nondiabetic subjects without prior
MI. Diabetic subjects without prior MI and nondiabetic subjects with prior MI had
intermediate survival rates as well as similar outcomes. These findings suggest that
cardiovascular risk factors should be treated in diabetic patients as aggressively as in
nondiabetic patients with prior MI. References
1. Haffner SM. The Scandinavian Simvastatin Survival Study (4S) subgroup
analysis of diabetic subjects: implications for the prevention of coronary heart disease. Diabetes
Care. 1997;20:469–471.
2. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from
coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with
and without prior myocardial infarction. N Engl J Med. 1998;339:229–234. |