Thursday, July 9, 2009

Does diabetes have the same coronary heart equivalence?

Here is an example of our current view of the risk of coronary artery disease in a diabetes patient:
  • This was a prospective cohort study of 7,052 men and 8,354 women aged 45–64 years from Renfrew and Paisley, Scotland, who were first screened in 1972–1976 and followed for 25 years. All-cause mortality was calculated as death per 1,000 person-years. A Cox proportional hazards model was used to adjust survival for age, smoking habit, blood pressure, serum cholesterol, BMI, and social class. Whiteley, july 2005
But a recent metananalysis has made the claim that this may not be the case:
  • "This meta-analysis did not support the hypothesis that diabetes is a 'coronary heart disease equivalent'. Public health decisions to initiate cardio-protective drugs in patients with diabetes for primary CHD prevention should therefore be based on appropriate patients' CHD risk estimates rather than a 'blanket' approach of treatment."
  • Click here to read further....




1 comment:

  1. This brings up a real interesting point. The study shows that there were 2432 CV events in diabetes group and 3750 in the prior MI group with the DM alone group being roughly 43% less. To me the 2432 is still a very high number of events. Unfortunately due to the meta-analysis, there is not a control group without dm or prior MI to compare with. If the control group has only 500 or so events, then DM group is a risk equivalent. However, if the number of events in the control group is around 1500 or more, then people with DM lie somewhere in the middle.
    Overall a good thought-provoking study, but with all the other data in terms of the benefit of statins in DM, I don't think this should change anyone's treatment protocol.


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