Diabetes mellitus

Assessing risk of coronary heart disease in patients with diabetes mellitus

Although most adult patients with diabetes mellitus are at high risk of CHD, the extent to which risk is increased varies greatly from one patient to another. It is therefore of paramount importance to assess global CHD risk in such patients in order to determine which risk factors confer the largest increase in risk for CHD and thus require the most aggressive treatment.

Important points to remember:

• Patients with type 2 diabetes and the metabolic syndrome exhibit the highest cardiovascular risk. Since moderate weight loss produces a selective loss of visceral fat and improves all features of the metabolic syndrome, weight loss is at a premium in this population.
• Diabetes abolishes the sex advantage with regard to coronary risk. Women with type 2 diabetes mellitus exhibit, on average, the same coronary risk as diabetic men of the same age.
• Patients with type 2 diabetes mellitus often display several conventional coronary risk factors. It is therefore important to calculate coronary risk using a scheme such as the PROCAM score that includes both diabetes and these factors. An alternative to the use of a general score such as PROCAM is to use a risk score specifically designed for diabetics. One such is the UKPDS Risk Engine, a type 2 diabetes–specific risk calculator based on 53,000 patient years of data from the United Kingdom Prospective Diabetes Study (www.dtu.ox.ac.uk/riskengine/index.php), which also provides an approximate margin of error for each estimate.