Diabetes and Coronary Risk Equivalency

The National Cholesterol Education Program Adult Treatment Panel III (ATP III) listed diabetes as a coronary heart disease (CHD) risk equivalent for setting therapeutic goals for LDL cholesterol (1). A goal for LDL cholesterol of 20%. For the majority of patients with diabetes, this LDL cholesterol goal would evoke the use of cholesterol-lowering drugs, particularly statins. Some investigators have questioned whether most or all patients with diabetes have a CHD risk equivalent and thus require cholesterol-lowering drugs (2). One approach to this issue is to examine epidemiological data relating to absolute risk for developing CHD in various populations of persons with diabetes. In the present issue of Diabetes Care , Howard et al. (3) reported the incidence of CHD in the Strong Heart Study, a cohort study of cardiovascular disease (CVD) in 13 American-Indian tribes/communities conducted in three study centers in southwestern Oklahoma, central Arizona, and North and South Dakota. The population of the Strong Heart Study has a high prevalence of type 2 diabetes and CVD associated with diabetes. The findings of this study showed wide variation in rates of CHD in patients with diabetes, depending in part on coexisting risk factors. Most individuals had 10-year risk >20%, the threshold for ATP III’s CHD risk equivalency, but only those with multiple risk factors had rates of CHD events equivalent to patients with established CHD. The authors conclude that it may be prudent to consider therapeutic goals for risk factors based on the entire risk factor profile, rather than just the presence of diabetes. Other studies likewise have found …