Evaluating the status of diabetes as a risk factor for coronary artery disease

Elevated plasma cholesterol is a major risk factor for coronary heart disea se (CHD) events, both in subjects with diabetes and in patients with establ ished coronary disease. Treatment guidelines, such as those from the Nation al Cholesterol Education Program, recommend lower cholesterol targets in pa tients with CHD than in those with diabetes. Some experts believe, however, that diabetic patients should be treated to the same cholesterol targets a s for CHD patients. This debate is compounded by the fact that the risk of CHD events in diabetics without prior CHD, compared with non-diabetics with prior CHD, is not fully established. My colleagues and I therefore examine d this issue by comparing the 7-year incidence of fatal and non-fatal myoca rdial infarction (MI) in diabetics and non-diabetics, from a Finnish popula tion-based study. We found that the risk of CHD mortality in diabetic subje cts without prior MI was similar to that in non-diabetic subjects with prio r MI. This observation, combined with previous studies showing the efficacy of lipid lowering in diabetic subjects with CHD, and the high mortality ra tes (including pre-hospital mortality) after an MI, suggest that all diabet ic subjects could be treated as if they had prior CHD.