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CHD: a major burden in type 2 diabetes
1Institute for the Prevention of Cardiovascular Disease, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Insights
Type 2 diabetes significantly increases cardiovascular mortality risk. Treating risk factors like high cholesterol with statins is crucial for diabetic patients to prevent heart events and strokes.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Patients with type 2 diabetes face a 2-4 times higher risk of cardiovascular mortality compared to non-diabetic individuals.
- Modifiable cardiovascular risk factors require management to prevent coronary events in the diabetic population.
- The Multiple Risk Factor Intervention Trial (MRFIT) identified serum cholesterol, systolic blood pressure, and smoking as key mortality predictors.
Purpose of the Study:
- To highlight the elevated cardiovascular risk in type 2 diabetes patients.
- To underscore the importance of managing dyslipidemia in diabetics.
- To provide a rationale for hypolipaemic therapy in this population.
Main Methods:
- Analysis of data from the Multiple Risk Factor Intervention Trial (MRFIT).
- Comparison of cardiovascular mortality rates between diabetic and non-diabetic men.
- Evaluation of lipoprotein profiles in diabetic patients.
Main Results:
- Diabetic men exhibited a three times higher age-adjusted coronary death rate than non-diabetic men at all risk factor levels.
- Diabetics present with dyslipidemia: high very low-density lipoprotein cholesterol and triglycerides, low high-density lipoprotein cholesterol.
- Diabetic patients have increased levels of atherogenic small dense LDL particles, conferring a 2-3 times higher risk for coronary events at any cholesterol level.
Conclusions:
- Diabetes significantly elevates cardiovascular risk, independent of other risk factors.
- Hypolipaemic therapy, particularly statins, is indicated for diabetic patients with dyslipidemia and coronary heart disease.
- Statins effectively lower cholesterol, combat atherosclerosis, and reduce stroke incidence.
Abstract:
Patients with type 2 diabetes have a two- to four-fold greater risk of cardiovascular mortality than non-diabetic individuals. In order to prevent coronary events in the diabetic population, it is important to treat modifiable cardiovascular risk factors. Data from the Multiple Risk Factor Intervention Trial (MRFIT) show that serum cholesterol level, systolic blood pressure level and cigarette smoking were significant predictors of cardiovascular disease mortality in men with and without diabetes. At every risk factor level, the absolute risk of age-adjusted coronary death rate was three times greater for diabetic men than non-diabetic men (p<0.0001). Patients with diabetes have an abnormal (dyslipidaemic) lipoprotein profile with high levels of very low density lipoprotein cholesterol and triglycerides, and a low level of high density lipoprotein cholesterol. Although levels of total cholesterol or low density lipoprotein (LDL) cholesterol do not differ significantly between patients with and without diabetes, those with diabetes have higher levels of atherogenic small dense LDL particles. MRFIT data show that at any serum cholesterol level, diabetes confers two-three times the risk for a coronary event. These findings constitute the rationale for considering hypolipaemic therapy, e.g. with HMG-CoA reductase inhibitors (statins), in diabetic patients with dyslipidaemia, particularly in those with evidence of coronary heart disease. Evidence shows that statins significantly lower cholesterol, exhibit beneficial effects on many components of atherosclerosis, and can significantly reduce the incidence of stroke.