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

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 todetermine which risk factors for coronary artery disease shouldbe included in a Cox proportional hazards model.
Subjects: 3055 white patients (mean age 52) with recently diagnosed type 2 diabetes mellitus and without evidence ofdisease related to atheroma. Median duration of follow up was7.9 years. 335 patients developed coronary artery disease within10 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 lipoproteincholesterol, decreased concentrations of high density lipoproteincholesterol, and increased triglyceride concentration, haemoglobinA_1c, systolic blood pressure, fasting plasma glucose concentration,and a history of smoking. The estimated hazard ratios for theupper third relative to the lower third were 2.26 (95% confidenceinterval 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 smokerswas 1.41(1.06 to 1.88).
Conclusion: A quintet of potentially modifiable risk factors for coronary artery disease exists in patients with type2 diabetes mellitus. These risk factors are increased concentrationsof low density lipoprotein cholesterol, decreased concentrationsof 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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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]