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Study in New England Journal (7/22/98)

A study to be published July 23 in the New England Journal of Medicine has shown that even if they have never had a heart attack, people with Type 2 diabetes (non-insulin dependent diabetes mellitus) have as high a risk for heart attack, stroke and cardiovascular (CV) death as non-diabetic people with heart disease.

Lead author on the report is Steven Haffner, MD, professor of medicine at The University of Texas Health Science Center at San Antonio.

Findings from the Coronary Heart Disease in Type 2 Diabetes Study show that during the seven-year follow-up period, the incidence of coronary events in diabetics without heart disease vs. non-diabetic patients with a history of heart disease was:
20.2 percent vs. 18.8 percent for heart attack
10.3 percent vs. 7.2 percent for stroke
15.4 percent vs. 15.9 percent for CV death

People with diabetes and a previous history of heart attack were found to be at the highest risk of a subsequent coronary event at 45 percent vs. 20.2 percent in people without a history of heart disease.

"Our results -- combined with previous studies that show the efficacy of lipid-lowering therapy in diabetic patients with heart disease, and the high mortality of people with diabetes after a heart attack -- suggest that all people with diabetes should have their cholesterol levels and other cardiovascular risk factors managed as aggressively as patients with known heart disease," Dr. Haffner said.

"Based on our study results, we know that people with diabetes have almost four times the risk of suffering a coronary event as non-diabetics. In people who already have had a heart attack, diabetes more than doubles the risk," he said. "Both patients and doctors need to be aware of the added risk that diabetes poses for heart disease and, where it is appropriate, take action through diet and medication to reduce the risk."

In April 1997, the journal Diabetes Care published the results of a post hoc analysis of a subgroup of 202 patients with diabetes from the Scandinavian Simvastatin Survival Study (4S). 4S was the first randomized, double-blind, placebo-controlled study to show that lowering cholesterol therapy can improve survival and outcomes in people with heart disease and high cholesterol. The subgroup analysis showed that major coronary events, including heart attacks, were reduced by 55 percent in people with diabetes taking simvastatin compared to those taking placebo.

The case for vigilant risk management is further supported by the profound increase in the incidence of diabetes in the United States. Another study from the Health Science Center presented at the American Diabetes Association's annual meeting showed that the increase may even threaten to stop or reverse the 30-year decline in heart disease.

"The increase in the number of people diagnosed with diabetes is having a dramatic impact on heart disease in this country. The evidence we have now should be used to clarify treatment guidelines for people with diabetes and to help prevent an increase in heart disease," said Dr. Haffner.

The Coronary Heart Disease in Type 2 Diabetes Study was an observational study designed to test the hypothesis that people with Type 2 diabetes have as high a risk for heart attack as non-diabetic patients with a prior history of heart attack. The seven-year incidence of fatal and non-fatal heart attack was followed in a total of 1,059 patients with diabetes and 1,373 patients without diabetes. The men and women in the study ranged in age from 45 to 64 and included people with and without a history of heart attack at baseline, as well as smokers and those with hypertension.

Elevated cholesterol levels were not a criteria for entry into the clinical trial.

Contact: Will Sansom (210) 567-2570