Speaker’s Notes/Talking Points:

The treatment of cardiovascular risk factors in patients with diabetes is controversial, with some investigators suggesting that such patients should be treated as though they had established coronary heart disease (CHD).1 To determine whether diabetic patients who have not had myocardial infarctions (MIs) should be treated as aggressively for cardiovascular risk factors as diabetic patients who have had MIs, Haffner and colleagues compared the 7-year incidence of MI (both fatal and nonfatal) among 1,378 nondiabetic subjects with the MI incidence among 1,059 subjects with non-insulin-dependent diabetes mellitus (NIDDM) in a Finnish population-based study.2  The probability of death from CHD was estimated among diabetic and nondiabetic subjects, with and without prior MI.  As this slide shows, the probability of death from CHD was highest among diabetic subjects with prior MI and was lowest among nondiabetic subjects without prior MI.  Diabetic subjects without prior MI and nondiabetic subjects with prior MI had intermediate survival rates as well as similar outcomes.  These findings suggest that cardiovascular risk factors should be treated in diabetic patients as aggressively as in nondiabetic patients with prior MI.

References

1. Haffner SM. The Scandinavian Simvastatin Survival Study (4S) subgroup analysis of diabetic subjects: implications for the prevention of coronary heart disease. Diabetes Care. 1997;20:469–471.

2. Haffner SM, Lehto S, Ronnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229–234.