Comparative approaches to risk reduction of coronary heart disease in Tecumseh non-insulin-dependent diabetic population

Analysis of 182 Tecumseh residents with non-insulin-dependent diabetes mellitus (NIDDM) and 364 controls matched for age and sex demonstrates increased levels of relative weight, blood pressure, and cholesterol in the diabetic group but similar smoking habits for the two groups. Consequently, the risk for acquiring coronary heart disease (CHD) in the next 8 yr calculated by the Framingham logistic regression equation shows a marked increase in risk for both men and women with diabetes (relative risk = 1.3 and 1.9, respectively). This calculated risk for CHD incidence predicts actual deaths from CHD, cardiovascular disease, and all causes in diabetic individuals in the succeeding 15 yr. Baseline levels of cholesterol, blood pressure, and smoking in the NIDDM population were hypothetically reduced according to results achieved in recent coronary-risk intervention trials. Average population risk for CHD incidence was recalculated and compared with new risk estimates calculated by hypothetically eliminating diabetes in various proportions of the population. Crude estimates suggest that realistic attempts to lower one, two, or three coronary risk factors in the population would reduce calculated CHD risk equivalent to eliminating diabetes in 20, 40, and 60% of the population, respectively.