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Nontraditional Risk Factors for Coronary Heart Disease among Persons with Diabetes FREE

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Copyright ©2004 by the American College of Physicians


Ann Intern Med. 2000;133(2):81. doi:10.7326/0003-4819-133-2-200007180-00021
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What is the problem and what is known about it so far?

Coronary heart disease is a condition in which the blood vessels that bring blood to the heart muscle become blocked. These blockages can lead to chest pain (angina) or heart attacks. Diabetes, a disease that affects how the body uses sugar and other nutrients, increases the risk for coronary heart disease. Other traditional risk factors for coronary heart disease include smoking, high blood pressure, heart disease in a parent or sibling before age 55, unfavorable cholesterol levels (high levels of low-density lipoprotein [LDL] cholesterol and low levels of high-density lipoprotein [HDL] cholesterol), and obesity. Other conditions may also be risk factors for heart disease. These conditions are called “nontraditional” risk factors because their relation to coronary heart disease is not yet proven. Knowing about nontraditional risk factors in people with diabetes might help researchers find better ways to prevent heart disease.

Why did the researchers do this particular study?

To examine the role of nontraditional risk factors for coronary heart disease in adults with diabetes.

Who was studied?

The study included 1676 people 45 to 64 years of age who had diabetes but no known coronary heart disease.

How was the study done?

At the beginning of the study, the researchers collected information about both traditional and nontraditional risk factors in all of the study patients. The nontraditional risk factors included 1) the ratio of a person's waist measurement to his or her hip measurement; 2) levels of types of fats in the bloodstream, called HDL3 cholesterol and apolipoproteins A1 and B; 3) blood levels of albumin, a substance that is related to nutritional status; 4) white blood cell counts; and 5) levels of four substances involved in blood clotting (fibrinogen, factor VII, factor VIII, and von Willebrand factor). They then followed the patients from 1987 through 1995 to see who developed coronary heart disease.

What did the researchers find?

After accounting for the traditional risk factors, diabetic persons with high fibrinogen levels, high factor VIII levels, high von Willebrand factor levels, high white blood cell counts, and/or low albumin levels were more likely than persons with low levels of these risk factors to develop coronary heart disease over the study period.

What were the limitations of the study?

We do not yet have treatments that can reliably change these nontraditional risk factors. Furthermore, we do not know whether changing them would actually help to prevent heart disease.

What are the implications of the study?

This study suggests that high fibrinogen levels, high factor VIII levels, high von Willebrand factor levels, high white blood cell counts, and/or low albumin levels may be associated with development of coronary heart disease in people with diabetes. This information may be helpful in developing ways to prevent heart disease.

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.

The summary below is from the full report titled “Nontraditional Risk Factors for Coronary Heart Disease Incidence among Persons with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study.” It is in the 18 July 2000 issue of Annals of Internal Medicine (volume 133, pages 81-91). The authors are I. Saito, A.R. Folsom, F.L. Brancati, B.B. Duncan, L.E. Chambless, and P.G. McGovern.

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.

The summary below is from the full report titled “Nontraditional Risk Factors for Coronary Heart Disease Incidence among Persons with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study.” It is in the 18 July 2000 issue of Annals of Internal Medicine (volume 133, pages 81-91). The authors are I. Saito, A.R. Folsom, F.L. Brancati, B.B. Duncan, L.E. Chambless, and P.G. McGovern.

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