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Dyslipidemia and hyperglycemia predict coronary heart disease events in middle-aged patients with NIDDM
S Lehto1, T Rönnemaa, S M Haffner
1Department of Medicine, Kuopio University Hospital, Finland.
Insights
Patients with non-insulin-dependent diabetes mellitus (NIDDM) face higher coronary heart disease (CHD) risks. Poor glycemic control and dyslipidemia significantly increase the likelihood of CHD events in these individuals.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Non-insulin-dependent diabetes mellitus (NIDDM) is a known risk factor for coronary heart disease (CHD).
- Limited data exists on the specific predictive value of cardiovascular risk factors and hyperglycemia in NIDDM patients for CHD.
- Prospective studies are needed to clarify these associations.
Purpose of the Study:
- To investigate the predictive value of cardiovascular risk factors and glycemic control for CHD events in NIDDM patients.
- To quantify the increased risk of CHD mortality and morbidity associated with specific risk factors.
- To provide evidence for risk stratification and management strategies in NIDDM.
Main Methods:
- A prospective follow-up study involving 1,059 NIDDM patients (aged 45-64 years).
- Baseline assessment of cardiovascular risk factors including lipid profiles and fasting plasma glucose.
- Follow-up for up to 7 years to record CHD events (mortality and nonfatal myocardial infarction).
Main Results:
- A history of myocardial infarction, low HDL cholesterol, high non-HDL cholesterol, high triglycerides, and high fasting glucose (>13.4 mmol/l) independently doubled CHD risk.
- High LDL cholesterol (> or =4.1 mmol/l) was linked to all CHD events.
- Combined high fasting glucose with dyslipidemia factors (low HDL, low HDL/total cholesterol ratio, high triglycerides) tripled CHD event risk.
Conclusions:
- Dyslipidemia and poor glycemic control are significant predictors of CHD mortality and morbidity in NIDDM patients.
- Specific lipid parameters and high fasting glucose levels identify high-risk individuals.
- These findings underscore the importance of managing metabolic factors to reduce cardiovascular risk in diabetes.
Abstract:
Patients with NIDDM are at increased risk for coronary heart disease (CHD). However, information on the predictive value of cardiovascular risk factors and the degree of hyperglycemia with respect to the risk for CHD in diabetic patients is still limited. Therefore, we carried out a prospective study on risk factors for CHD, including a large number of NIDDM patients. At baseline, risk factor levels of CHD were determined in 1,059 NIDDM patients (581 men and 478 women), aged from 45 to 64 years. These patients were followed up to 7 years with respect to CHD events. Altogether, 158 NIDDM patients (97 men [16.7%] and 61 women [12.8%]) died of CHD and 256 NIDDM patients (156 men [26.8%] and 100 women [20.9%]) had a serious CHD event (death from CHD or nonfatal myocardial infarction). A previous history of myocardial infarction, low HDL cholesterol level (<1.0 mmol/l), high non-HDL cholesterol (> or =5.2 mmol/l), high total triglyceride level (>2.3 mmol/l), and high fasting plasma glucose (>13.4 mmol/l) were associated with a twofold increase in the risk of CHD mortality or morbidity, independently of other cardiovascular risk factors. High calculated LDL cholesterol level (> or =4.1 mmol/l) was significantly associated with all CHD events. The simultaneous presence of high fasting glucose (>13.4 mmol/l) with low HDL cholesterol, low HDL-to-total cholesterol ratio, or high total triglycerides further increased the risk for CHD events up to threefold. Our 7-year follow-up study provides evidence that dyslipidemia and poor glycemic control predict CHD mortality and morbidity in patients with NIDDM.