Thursday, June 9, 2016

Diabetes is not CAD equivalent anymore

Diabetes and Prior Coronary Heart Disease are Not Necessarily Risk Equivalent for Future Coronary Heart Disease Events

The prevalence and burden of diabetes mellitus remains high.After Haffner et al.reported that adults with diabetes had the same risk for future myocardial infarction (MI) as adults with previous MI and without diabetes, the Adult Treatment Panel (ATP) III guidelines in 2001 recommended that all individuals with diabetes be considered as “Coronary heart disease (CHD) risk equivalent”.However, the latest 2013 ACC/AHA assessment of risk guidelines considers diabetes as only one of the many variables in its risk assessment equation.
The assertion that all patients with diabetes are CHD equivalent has been controversial.Existing evidence is based on relatively small studies with various limitations.
Some studies were limited to a single gender, while others were based on self-reported diagnosis of diabetes.

Some lacked the ability to adjust for important confounding risk factors.Most of the studies have comprised cohorts from the 1990s, and only a few studies have been able to evaluate the impact of the duration of diabetes. There is also a paucity of data among relatively young (30–40 years) patients with diabetes. For all these reasons, updated evidence from a contemporary population is needed to inform our understanding of CHD risk in diabetes patients

Based on a recent examination of the 2013 ACC/AHA Pooled Cohort Equation, the inclusion of diabetes in the scoring criteria rather than considering diabetes as an automatic CHD equivalent led to important differences in predicted risk that might influence decision-making in younger patients with diabetes.

The recent study expressed as follow:

-Individuals with diabetes alone had significantly lower risk of CHD across all age and sex strata compared to those with CHD alone (12.2 versus 22.5 per 1000 person-years).
-The risk of future CHD for patients with a history of either DM or CHD was similar only among those with diabetes of long duration (≥10 years) to can call diabetes equivalent.
-Not all individuals with diabetes should be unconditionally assumed to be a risk equivalent of those with prior CHD.

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