Capsule Commentary on Rana et al Diabetes and Pr

Authors: Tiffany M PowellWiley

Publish Date: 2016/02/12

Volume: 31, Issue: 4, Pages: 413-413

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Abstract

The prevalence of diabetes mellitus DM has risen dramatically over the past decades as obesity rates have increased in the United States Recent estimates suggest that approximately 9 of the US population or over 29 million Americans have DM with the great majority having Type 2 DM1 While cardiovascular disease is known to be the leading cause of death among those with diabetes2 there has been controversy as to whether prevalent diabetes portends the same risk for future cardiovascular events as prevalent coronary heart disease CHD Delineating diabetes as a CHD equivalent or a CHD risk factor is critical to improving the accuracy of cardiovascular risk prediction and in developing tailored risk reduction strategiesRana and colleagues analyzed electronic health record data from the Kaiser Permanente Northern California health care system which includes over 15 million members3 This study demonstrated that the risk of a CHD event over a 10year followup period was significantly lower for those with diabetes alone as compared to those with prior CHD these findings appear to refute previous data showing that prevalent diabetes is a CHD equivalent4 Most interestingly those with diabetes for the longest duration or for ten or more years in the cohort had a similar risk of CHD events as those with CHD aloneThe findings are robust given that much of the prior data examining diabetes as a CHD risk equivalent comes from metaanalyses with inherent methodologic limitations and this study was done in a large ethnically and racially diverse population from a realworld setting Additionally sexstratified analyses of CHD event rates in this population help to identify whether CHD risk based on prevalent diabetes differs between men and women One area for future work with this study cohort would be to evaluate differences in CHD event rates across racial and ethnic groups among those with diabetes and/or CHD as compared to those without either disease Overall these findings support the use of outcomes data from diverse patient populations for creating and refining cardiovascular risk prediction models as was used in the creation of the 2013 ACC/AHA cardiovascular risk estimator5The author has no conflict with any of the material in this manuscript Funding support for the author is provided by the Division of Intramural Research of the National Heart Lung and Blood Institute NHLBI at the National Institutes of Health NIH The views expressed in this manuscript are those of the author and do not necessarily represent the views of the National Heart Lung and Blood Institute the National Institutes of Health or the US Department of Health and Human Services

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