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R C Turner Diabetes Research Laboratories,
Nuffield Department of Medicine, University of Oxford, Radcliffe
Infirmary, Oxford OX2 6HE
Correspondence to: Professor
Turner robert.turner{at}drl.ox.ac.uk
Objective: To evaluate baseline risk factors for
coronary artery disease in patients with type 2 diabetes mellitus.
Design: A stepwise selection procedure, adjusting for
age and sex, was used in 2693 subjects with complete data to determine
which risk factors for coronary artery disease should be included in a
Cox proportional hazards model.
Subjects: 3055 white patients (mean age 52) with
recently diagnosed type 2 diabetes mellitus and without evidence of disease related to atheroma. Median duration of follow up was 7.9 years. 335 patients developed coronary artery disease within 10 years.
Outcome measures: Angina with confirmatory abnormal
electrocardiogram; non-fatal and fatal myocardial infarction.
Results: Coronary artery disease was significantly
associated with increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, and increased triglyceride concentration, haemoglobin A1c, systolic blood pressure, fasting plasma glucose
concentration, and a history of smoking. The estimated hazard ratios
for the upper third relative to the lower third were 2.26 (95%
confidence interval 1.70 to 3.00) for low density lipoprotein
cholesterol, 0.55 (0.41 to 0.73) for high density lipoprotein
cholesterol, 1.52 (1.15 to 2.01) for haemoglobin A1c, and
1.82 (1.34 to 2.47) for systolic blood pressure. The estimated hazard
ratio for smokers was 1.41(1.06 to 1.88).
Conclusion: A quintet of potentially modifiable risk
factors for coronary artery disease exists in patients with type 2 diabetes mellitus. These risk factors are increased concentrations of
low density lipoprotein cholesterol, decreased concentrations of high
density lipoprotein cholesterol, raised blood pressure, hyperglycaemia,
and smoking.
Key messages
© BMJ 1998
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