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[IPu] Diabetes Adds 15 Years to Heart Attack Risk Calculation (Medpage)



Hi All,
Diabetes certainly increases the chances of Heart Disease etc, which is why
Endos trat it more
aggressively in the Diabetic population.  But this article actually lists
specific ages for concern.
Worth reading ...
Janette








     Diabetes Adds 15 Years to Heart Attack Risk Calculation

        By Peggy Peck, Managing Editor, MedPage Today
            Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and
Hypertension Division, University of Pennsylvania School of Medicine
            June 29, 2006


                  MedPage Today Action Points


                    a.. Explain to patients who ask that this report suggests
that middle-aged diabetics may require aggressive therapy to lower risk of
cardiovascular events.


                    b.. Be aware that these data suggest that younger
diabetics have a low to moderate risk of cardiovascular events.


            Review
            TORONTO, June 29 - Diabetes is the clinical equivalent of aging 15
years, thrusting men and women with the disease into a high-risk category for
cardiovascular disease while still in middle-age.

            A 48-year-old diabetic man has a 20% risk of suffering an acute
myocardial infarction by age 58, wrote Gillian L. Booth, M.D., and colleagues,
of the University of Toronto in the July 1 issue of The Lancet.


            Similarly, a 54-year-old woman with diabetes has a one in five
chance of having a heart attack before she reaches retirement age.


            Moreover, women ages 20 to 34 who have diabetes have acute
myocardial infarction rates that are nearly 40 times higher than their
age-matched non-diabetic counterparts.


            But that rate increase does not boost diabetic women in their 20s
and 30s into the high-risk category for cardiovascular disease and their event
rate is lower than the rate observed in non-diabetics who have established
coronary heart disease.


            Dr. Booth and colleagues conducted a retrospective cohort study of
379,003 adults with diabetes and 9,018,082 adults without diabetes living in
the Canadian province of Ontario. The study included all Ontario residents who
were age 20 or older on April 1, 1994, and followed them, recording all
cardiovascular disease events until March 31, 2000.


            The study did not distinguish between type 1 and type 2 diabetes.


            The authors defined high risk as a fatal or non-fatal coronary
heart disease event rate equivalent to a 10-year risk of 20% or more or a rate
equal to the risk in people who have already had a myocardial infarction.


            In both diabetics and non-diabetics, the risk of heart disease
increases with age, but for men and women with diabetes the transition from
moderate to high risk occurred at about age 48 for men and 54 for women, which
was 14.6 years earlier than transition in non-diabetics.


            Diabetes also eliminated much, but not all, of the gender gap in
heart disease. In non-diabetics the age-adjusted hazard ratio for incident
acute myocardial infarction was 2.56 for men compared with women (95% CI
2.53-2.60); after adjusting for other risk factors, "men with diabetes were
1.22 times more likely to have an [acute myocardial infarction] than women
with diabetes."


            The data suggest that "young adults with diabetes have rates of
[coronary heart disease] 12 to 40 times higher than those in people of the
same age without diabetes. However, absolute rates of coronary events and
[cardiovascular disease events] in general, were lower in this younger group
than the rates conventionally regarded as high risk, and lower than those of
people without diabetes with established [coronary heart disease]."


            The study relied on medical records to identify people with
diabetes, so it possible that the "use of our algorithm would not have
identified people with undiagnosed diabetes." But that omission would have
biased the study towards a null hypothesis, they wrote.


            A second limitation is the failure to discern use of
cardioprotective drugs in patients of all ages. But prescription records were
available for people ages 65 or older, and from 1994 through 1999 only 8% to
25% of Ontario residents age 65 or older were taking lipid-lowering
medications, and 25% to 37% were taking ACE inhibitors. Those rates indicate
that it is unlikely that there was substantial use of those drugs in younger
residents.


            The authors concluded that "middle-age and older people with
diabetes seem on average to be at high risk of [cardiovascular disease], thus
aggressive risk-reduction strategies are warranted for them."


            Younger people with diabetes appear to be at low to moderate risk,
thus the data support present guidelines recommending that risk-reduction
efforts be individualized in patients with diabetes who are younger than 40.



            Primary source: The Lancet
            Source reference:
            Booth GL et al "Relation between age and cardiovascular disease in
men and women with diabetes compared with non-diabetic people: a
population-based retrospective cohort study." Lancet 2006; 368:29-36

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