Aims Current guidelines for lipid lowering as primary prevention advocate a treatment threshold 10-year coronary heart disease (CHD) risk of ≥ 30%. There is a variety of methods of calculating CHD risk, of varying complexity, which incorporate different factors. We aimed to determine if different methods of CHD risk calculation give different results and if a simpler method of CHD risk calculation could be developed for type 2 diabetes.
Methods Using three recognised methods based on the Framingham equation, CHD risk was calculated for 200 consecutive patients with type 2 diabetes attending the clinic. A simple method of establishing those who should be treated with lipid-lowering agents was developed and sensitivity and specificity compared to the established method.
Results Using method 1, only 58 (29%) of the patients would be above the treatment threshold; 108 (54%) with method 2; and 140 (70%) with method 3 ( 2=68.3, p < 0.001). Using the Glasgow Chart, sensitivity and specificity would be 100% and 85% respectively if patients are identified with total cholesterol ≥ 5.0 mmol/L plus two of: 1) age ≥ 50 years; 2) blood pressure ≥ 140/80 mmHg; 3) microalbuminuria.
Conclusions It makes a significant difference which method is used to calculate CHD risk. Our simple method seems to be applicable to patients with type 2 diabetes, but requires confirmation in a larger population.
Kannel WB, McGee DLDiabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study. Diabetes Care1979;2(2): 120-6.
2.
Hansson L., Zanchetti A., Carruthers SG et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet1998;351:1755-62.
3.
Pyorala K., Pedersen TR, Kjekshus J., Faergeman O., Olsson AG, Thorgeirsson G.Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S). Diabetes Care1997;20:614-20.
4.
Sacks FM, Pfeffer MA, Moye LA et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med1996;335:1001-9.
5.
The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group.Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med1998;339:1349-57.
6.
UK Prospective Diabetes Study (UKPDS) Group.Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet1998;352:854-65.
7.
Meade T., Sleight P., Collins R. et al. MRC/BHF Heart Protection Study of cholesterol-lowering therapy and of antioxidant vitamin supplementation in a wide range of patients at increased risk of coronary heart disease death: Early safety and efficacy experience. Eur Heart J1999;20:725-41.
8.
Haffner SM, Lehto S., Ronnemaa T., Pyorala 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 Med1998;339:229-34.
9.
Haffner SMIs all coronary heart disease prevention in type 2 diabetes mellitus secondary prevention?J Clin Endocrinol Metab2000;85:2108-10.
10.
Wood D., Durrington P., Poulter N., McInnes G., Rees A., Wray R.Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart1998;80(suppl 2):S1-S29.
11.
Ramsay LE, Williams B., Johnston GD et al. Guidelines for management of hypertension: Report of the third working party of the British Hypertension Society. J Hum Hypertens1999;13:569-92.
12.
Peters TJ, Montgomery AA, Fahey T.How accurately do primary health care professionals use cardiovascular risk tables in the management of hypertension?Brit J Gen Pract1999;49:987-8.
13.
Wood D., De Backer G., Faergeman O., Graham I., Mancia G., Pyorala K.Prevention of coronary heart disease in clinical practice. Summary of recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. J Hypertens1998;16:1407-14.
14.
Yudkin JS, Chaturvedi N.Developing risk stratification charts for diabetic and nondiabetic subjects . Diabet Med1999;16:219-27.
15.
Grover SA, Coupal L., Zowall H., Alexander CM, Weiss TW, Gomes DRJ.How cost-effective is the treatment of dyslipidemia in patients with diabetes but without cardiovascular disease?Diabetes Care2001;24:45-50.
16.
Rubins HB, Robins SJ, Collins D. et al. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med1999;341:410-18.
17.
Arthur R.DAIS results show benefits of fenofibrate in diabetes. Brit J Cardiol2000;7:455-6.
