The scope for cardiovascular disease risk factor intervention among peoplewith diabetes mellitus in England: a population-based analysis from the Health Surveys for England 1991-94

Aims. To examine the scope for cardiovascular disease risk factor intervent ion among diabetic patients in England was examined using data from the Hea lth Surveys for England 1991-94 This evaluation included calculating the pr oportion who require lipid lowering therapy according to the Standing Medic al Advisory Committee (SMAC) guidelines. Methods. The Health Survey for England is an annual, nationwide household-b ased in which anthropomorphic data, blood pressure, lipids and details of c ardiovascular risk factors are collected from households after random strat ification for geographical and socio-economic factors within a population s ample of 39639 adults, 970 (2.3%) diabetic subjects were identified. Results. Overall, 51% of those with diabetes had hypertension (systolic blo od pressure greater than or equal to 160 mmHg or a diastolic BP greater tha n or equal to 95 mmHg or being on antihypertensive therapy), 27% were obese (body mass index greater than or equal to 30 kg/m(2)) and 19% were current smokers. One-third of those with hypertension were untreated and less than one-half oi those on treatment had their hypertension controlled to below 160/ 95 mmHg. More than one-quarter had poor glycaemic control (glycated Hb > 11% or an HbA(1C) > 7.5%). Of those aged <70years, 29% required lipid lo wering therapy according to the SMAC guidelines and almost all (94%) Of the se were not on treatment. An analysis showed that, because the SMAC guideli nes do not require high density lipoprotein (HDL) cholesterol to be measure d, their use is likely to result in substantial underestimation of the need for lipid lowering, particularly in diabetic women. Conclusion. In England, among those with diabetes there is considerable unm et need for cardiovascular risk factor intervention, particularly for hyper tension and raised cholesterol. With this baseline established, future impr ovements can be monitored.