THURSDAY, April 18, 2002 (HealthDayNews) -- The risk of coronary heart disease may not be as high in people with type II (adult onset) diabetes as previously thought.
Earlier reports had suggested that the risk of death from heart disease for otherwise healthy people with diabetes was as high as that found in people with a history of heart disease. But a new study by Scottish researchers says that the risk for people with diabetes is lower.
While people with diabetes still face a higher-than-average risk of heart problems, say the researchers, doctors shouldn't treat them as if they have heart disease without considering other risk factors like smoking or cholesterol levels.
Experts says the findings, which appear in the April 20 issue of the British Medical Journal, are not completely surprising.
According to Dr. Andrew Morris, the report's senior investigator, the goal of the study was to find the exact risk of future heart disease in people with type II diabetes.
Morris, a reader in medicine at the University of Dundee and Ninewells Hospital in Dundee, U.K., says it's an acknowledged fact that people with type II diabetes are at an increased risk of cardiovascular disease, specifically coronary vascular disease. But he says that there remained some uncertainty over how great that risk is in patients with diabetes.
The researchers found that the risk of death was 33 percent higher among patients with a history of heart attack than among those with diabetes, while the risk of hospital admission was nearly 2.3 times higher in the group with a prior heart attack.
"We have clearly shown that the risk is increased if you have diabetes, but the magnitude of risk is not as great as if you'd just had a heart attack," says Morris. "What it enables us to do is to put a precise figure on what the risk is."
"People have used type II diabetes to classify patients at this highest possible risk category," says Morris. "Our argument is that you need to look at the combination of risk factors for heart disease, of which diabetes is just one. It's a matter of looking at the overall risk profile
not just the diabetic state itself."
"Type II diabetes is associated with an increased risk of heart disease," says Morris. "They should ensure that they attend for regular checks, so that they can get their diabetes well controlled, as well as blood pressure, cholesterol, stopping smoking -- all these good lifestyle issues which have been clearly shown to improve outcome for individual patients."
Dr. Bernd Waldecker, a professor of cardiology at the Justus-Liebig University Giessen in Giessen, Germany, has studied cardiovascular risk in patients with type II diabetes. He says it not entirely surprising that the risk is not as high in diabetic patients.
Still, he says, "their risk for cardiovascular disease is definitely increased when you compare the person to [those] who have no diabetes."
"The risk not only refers to coronary artery disease, but refers basically to all atherosclerotic disease," he says, adding the risk of disease is increased "several-fold" and occurs more rapidly in people with diabetes.
Dr. Hertzel Gerstein, director of the Diabetes Care and Research Program at McMaster University in Hamilton, Ontario, says the relative risk to heart attack victims is low, but the overall risk is high. The overall risk of death from a cardiovascular event is two to four times higher in diabetics than in non-diabetics.
"The reason that this paper is important
is because today in the year 2002, we have available to us several proven therapies that clearly can reduce the risk of death and heart attacks and strokes for people with diabetes who've had a previous heart attack and in people with diabetes who've not had a previous heart attack," says Gerstein.
He says it's up to people with diabetes to do their research and work with their physician to find the best strategy for reducing their risk.
What To Do
Find out more about the cardiovascular complications of diabetes from the National Institute of Diabetes & Digestive and Kidney Diseases, the
Joslin Diabetes Center or the American Diabetes Association.
