BMJ 1998;316:823-828 ( 14 March )

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Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23)

R C Turner, professor of medicine,  H Millns, statistician,  H A W Neil, lecturer in clinical epidemiology,  I M Stratton, statistician,  S E Manley, biochemist,  D R Matthews, consultant physician in diabetes,  R R Holman, reader in medicine. 

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 A_1c, 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 A_1c, 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 Coronary artery disease is the major cause of mortality in patients with type 2 diabetes mellitus Patients without evidence of disease related to atheroma at diagnosis of type 2 diabetes mellitus had an increased standardised mortality ratio compared with the population of the United Kingdom 11% of patients in this study had a myocardial infarction or developed angina over a median of 8 years' follow up The potentially modifiable risk factors for coronary artery disease were increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, hypertension, hyperglycaemia, and smoking; these are also risk factors for coronary artery disease in the general population Evidence is needed on whether modifying these risk factors will reduce coronary artery disease in patients with type 2 diabetes mellitus

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Rapid Responses:

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To find the actual risk factors for coronary artery disease in non-insulin dependent diabetes mellitus, influence of the LADA patients should be removed

Arya K Kumarasena
bmj.com, 26 Feb 2008 [Full text]