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Risk Factors for Coronary Heart Disease in Diabetes
Persons with diabetes are disproportionately affected by coronary heart disease. Furthermore, diabetic patients have not benefited from the advances in the management of coronary heart disease or its risk factors, which have decreased mortality from coronary heart disease in persons without diabetes (1). Some of the excess risk in persons with diabetes is related to an increased prevalence of established risk factors, such as obesity, dyslipidemia, and hypertension. Nevertheless, traditional risk factors do not fully explain the excess risk for coronary heart disease in these persons (2). Therefore, other, “nontraditional” risk factors may be important in diabetes.
In this issue, the investigators of the Atherosclerosis Risk In Communities (ARIC) Study examined the role of nontraditional risk factors for coronary heart disease in adults with type 2 diabetes (3). They report that in addition to being associated with traditional risk factors, the incidence of coronary heart disease in patients with diabetes was significantly associated with waist-to-hip ratio; levels of high-density lipoprotein-3 cholesterol, apolipoproteins A-1 and B, albumin, factor VIII, and von Willebrand factor; and leukocyte count. However, after adjustment for traditional risk factors, only levels of albumin, fibrinogen, factor VIII, and von Willebrand factor and leukocyte count remained independently associated with coronary heart disease. The ARIC Study is the first prospective study to report these associations of nontraditional risk factors for coronary heart disease in diabetes independent of traditional risk factors.
The findings of the ARIC study provide additional insights into the pathogenesis of coronary heart disease in diabetes. All of the risk factors identified may reflect underlying inflammation that may be secondary to atherosclerosis or may represent a nonspecific inflammatory response to infections, which are likely to be much more common in persons with uncontrolled diabetes. Even if the increase in levels of these risk …
