Intended for healthcare professionals


Prediction of cardiovascular risk

BMJ 1999; 318 doi: (Published 22 May 1999) Cite this as: BMJ 1999;318:1418

Program is not suitable for diabetic patients

  1. Andrew Zambanini, Senior registrar in clinical pharmacology,
  2. Martin R Smith, Specialist registrar in diabetes and endocrinology,
  3. Michael D Feher, Senior lecturer in clinical pharmacology
  1. Section of Clinical Pharmacology, Imperial College School of Medicine and Beta Cell Diabetes Centre, Chelsea and Westminster Hospital, London SW10 9NH
  2. Clinical Pharmacology Unit, EA 643, Claude Bernard University, BP 3041, 69394 Lyons Cedex 03, France
  3. Centre for Clinical Pharmacology, Department of Medicine, University College London, Rayne Institute, London WC1E 6JJ

    EDITOR—Hingorani and Vallance describe a clinic based computer program for the management of cardiovascular risk factors.1 However, the program has limitations for diabetic patients.

    This program and previous methods, together with the recent joint British recommendations,2 are based on algorithms derived from the Framingham heart study of 5573 people aged 30-74 years originally screened in 1968. However, only 4% (237 subjects) of this cohort had diabetes, as defined by a random glucose concentration >9 mmol/l or the use of diabetic treatment. Importantly, diabetes was not classified according to type, and the presence of proteinuria or microalbuminuria (important cardiovascular risk factors in diabetes) were not included.

    The prevalence and characteristics of other risk factors further highlight that people with diabetes are not average patients3; “diabetic dyslipidaemia,” increased prevalence of hypertension, and ethnic origin (for example, south Asian) contribute to an increased atherogenic potential. Despite the strong link between triglyceride concentration and coronary heart disease in diabetes, this important risk factor was omitted from the program.

    The glycaemic state was included in the program as a risk factor both as “diabetes” and as a blood glucose concentration. The impact of glycaemia on cardiovascular events is not dichotomous, but, like blood pressure, has a continuous relation.4 The inclusion …

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