Diabetes mellitus and CV risk — Although some guidelines have considered all patients with diabetes mellitus (DM) to have a risk of CV events similar to patients with known CVD, this actually averages events across patients with widely differing risks of CHD. Issues that may affect risk with DM include patient age, sex, other CV risk factors, duration of DM, and whether the patient has type 1 or type 2 DM.
A prospective cohort study that followed more than 1.5 million adults (ages 30 to 90) for a median of 9.9 years found a lower rate of new CHD events in patients with DM than in those with a prior CHD event (12.2 versus 22.5 events per 1000 person-years); the risk of events was similar to that with prior CHD only in patients who had DM for more than 10 years. Given this, it is preferable to calculate patient-specific risks rather than to simply consider all patients with DM to require…
