Editorials

Diabetes care needs evidence based interventions to reduce risk of vascular disease

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7249.1554 (Published 10 June 2000) Cite this as: BMJ 2000;320:1554

Individual risk factors in isolation are poor predictors of risk

  1. Christopher D Byrne, professor, endocrinology and metabolism (cdtb@soton.ac.uk),
  2. Sarah H Wild, lecturer, public health medicine (sarahwild@doctors.org.uk)
  1. University of Southampton, School of Medicine, Southampton General Hospital, Southampton SO16 6YD
  2. Health Care Research Unit, University of Southampton, School of Medicine

    The absolute risk of a first myocardial infarction is influenced by factors that include age, sex, blood pressure, the total concentration of high density lipoproteins, the cholesterol ratio, and diabetes.1 The prevalence of diabetes increases with age, and having the disease removes the protective effect of female sex against cardiovascular disease. Diabetes is commonly associated with hypertension, and an unfavourable lipid pattern combined with these factors contributes to the increase in the relative risk of myocardial infarction. In people with type 2 diabetes the risk of myocardial infarction is between two and six times higher than that of the general population.

    The initial threshold for using lipid lowering treatment for the primary prevention of myocardial infarction as recommended by European and British guidelines is 2% and 3% risk per year, respectively.1 2 This is similar to the average risk of recurrence of a myocardial infarction.3 4 People who have had a first myocardial infarction are considered to be at a sufficiently high risk to be eligible for secondary prevention with lipid lowering treatment,1 whereas many people who have never had a myocardial infarction have a risk well below the threshold. In contrast, people with diabetes and a single other cardiovascular risk factor may have a risk of a …

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