Predicted risk of coronary heart disease among persons with type 2 diabetes

BACKGROUND: Diabetes is an independent risk factor for the development of coronary heart disease (CHD). We evaluated whether there are racial/ethnic differences in predicted probability of CHD among persons with type 2 diabetes from the 1999-2002 National Health and Nutrition Examination Survey. METHODS: Adults with type 2 diabetes without cardiovascular disease (n=585) were evaluated; the United Kingdom Prospective Diabetes Study (UKPDS) Risk Engine was used to develop estimates of CHD and Framingham Risk Score (FRS) was used to assess the 10-year CHD risk. Chi-square tests and analysis of variance were used to assess differences between racial/ethnic groups in risk factors and predicted probability for CHD. RESULTS: Risk factors for CHD differed significantly amongst the three racial/ethnic groups. Whites had lower mean A1C concentrations (7.3%+/-0.2) than blacks (8.1%+/-0.2, P<0.05) or Mexican Americans (8.1%+/-0.2, P<0.05). Systolic blood pressure was higher in blacks compared with whites (P<0.05) and in Mexican American men compared with white men (P<0.05). Total cholesterol differed insignificantly by race/ethnicity whereas high-density lipoprotein cholesterol was higher in blacks compared with whites and Mexican Americans. Blacks had the greatest 5, 10, 15, and 20-year predicted risks of CHD among men, whereas whites had the greatest predicted risks among women. When evaluated by the FRS, the 10-year predicted risk of CHD was estimated to be 22.5% by UKPDS and 17% using FRS. CONCLUSIONS: UKPDS estimates of probability of CHD were similar across race/ethnicities, indicating that the risk factors tended to balance out. Despite differences in individual risk factors, the estimated risk for CHD was similar for all persons with diabetes.