Date: Epub online March 31, 2008

Summary: A study of 3.3 million Danes age 30 and older showed that people who have diabetes and require treatment to lower blood sugar levels have the same risk of dying of heart disease as do people who have had a previous heart attack and do not have diabetes.

Journal: Circulation

Journal citation: Circulation 2008:117;1948-1954.

Read the original article: http://circ.ahajournals.org/cgi/reprint/117/15/1945

Why it’s important: People who have diabetes have an increased risk of developing heart disease. However, clinical practice guidelines have varied greatly in their recommendations as to when diabetes patients should begin receiving intensive treatment for other heart disease risk factors in addition to receiving glucose lowering therapy for their diabetes. These differences in guidelines have been driven mainly by uncertainty of cardiovascular risk levels in diabetes patients as they relate to age, because few studies have examined cardiovascular risk in younger patients with diabetes. This study indicates that people age 30 and older with diabetes (and no prior heart attack) have a risk of dying of heart disease that is comparable to patients without diabetes who have had a prior heart attack.

What’s already known: Many standard recommendations for preventing heart disease in people with diabetes differ with respect to risk in younger patients. These recommendations usually refer to treatment of type 2 diabetes, which usually occurs in adulthood. However, with rising rates of obesity, people are developing type 2 diabetes at younger ages. There are also differences with respect to age and risk levels among recommendations for people with type 1 or juvenile diabetes. In addition, some of the recommendations for anti-platelet therapy to prevent clotting in diabetes patients differ with respect to age and concurrent problems that would prompt treatment. Only a few studies have looked at the risk of heart disease in younger people.

How this study was done: Researchers followed the medical history of the Danish population who were at least 30 years of age and alive on January 1, 1997 in national population registries for five years (1997–2002) . They compared people with diabetes receiving treatment to lower their blood sugar to people without diabetes and who had a previous heart attack.

What was found:  In 1997, 71,801 people were identified who were being treated for diabetes and 79,575 people were identified who previously had a heart attack. When the researchers studied people who died of heart-related problems during the study, they found that the risk was virtually the same among people with diabetes and no prior heart attack as it was among people without diabetes and no prior heart attack.

For women, the risk was 2.45 times greater in those with diabetes and 2.62 times greater for those without diabetes and with prior heart attack.  For men, the relative risk was 2.42 greater in those with diabetes and 2.44 times greater for those without diabetes and with prior heart attack. 

The researchers wrote: “The major finding of this study is that all patients age 30 and older who require glucose-lowering treatment are at a particularly high risk of cardiovascular death and disease, comparable to that of nondiabetics with a prior heart attack, regardless of sex and diabetes type."

“The increased risk was observed in people at all ages with either type 1 or type 2 diabetes who were receiving insulin or other drugs to reduce levels of sugar in the blood,” said Tina Ken Schramm, M.D., lead author of the study and research fellow at the Gentofte Hospital in Hellerup, Denmark.

“When people with diabetes do have heart attacks, they are twice as likely to die as non-diabetics. We’ve talked about ‘the lower, the better’ for cholesterol and blood pressure to reduce the risk of heart attack,” Dr. Schramm said. “Now I think we should be saying ‘the sooner, the better’ for primary prevention of cardiovascular diseases in diabetics.”

The researchers concluded that people who receive treatment to lower their blood sugar because of diabetes should, at the same time, receive treatment to reduce their risk of heart disease, including cholesterol-lowering drugs, medicines to reduce the risk of clotting, blood pressure medications and other medications.

The bottom line:  If you have diabetes, seek treatment to reduce your risk of heart disease as well. It could be a lifesaving decision.



This content is reviewed regularly. Last updated 05/27/08.