By Ed Edelson
Tuesday, August 14, 2007 12:00 AM
TUESDAY, Aug. 14 (HealthDay News) -- Most people know that diabetes is a risk factor for heart disease, but a new report puts some hard numbers on what that increased risk means for people who suffer what cardiologists call acute coronary syndromes -- cardiac events ranging from a chest pain called unstable angina to a heart attack.
For example, 8.5 percent of people with diabetes who have severe heart attacks die within 30 days, compared to 5.4 percent of those who do not have diabetes. After compensating for factors such as age -- older people are more likely to have diabetes -- that translates to an 80 percent increased risk of death within one month, according to the researchers.
"Despite all the wonderful advances we have made in cardiology, people with diabetes don't enjoy the same magnitude of benefit," said study author Dr. Elliott M. Antman, a senior investigator at Brigham and Women's Hospital, in Boston.
The findings are published in the Aug. 15 issue of theJournal of the American Medical Association.
The researchers used data on more than 62,000 people enrolled in 11 related trials that evaluated therapies for acute coronary syndromes. The numbers were universally grim for the 17 percent of people with diabetes.
The increased risk was very evident for people who had unstable angina and less severe heart attacks -- a 2.1 percent death rate over 30 days for diabetics, compared to 1.1 percent for non-diabetics.
And the risk persists. The study found that one year after an acute coronary syndrome, the death rate for diabetics who had unstable angina and a mild heart attack was close to that of non-diabetics who suffered severe heart attacks -- 7.2 percent vs. 8.1 percent.
"We need aggressive strategies to manage the diabetic population," Antman said. "What we need to do is everything to halt the epidemic of diabetes and find through research what therapies are most helpful for diabetic patients. We've got to do better for those patients."
The American Diabetes Association estimates that almost 21 million children and adults in the United States -- or 7 percent of the population -- have diabetes. While an estimated 14.6 million of those people have been diagnosed with diabetes, 6.2 million people (or nearly one-third) don't know they have the disease. And almost 95 percent of American diabetics have type 2 diabetes, which is typically caused by excess weight.
The numbers in the new study come as no surprise to Dr. Larry C. Deeb, president of medicine and science for the American Diabetes Association and a clinical professor of pediatrics at the University of Florida.
"Everyone in his right mind has known that people with diabetes have been dying more regularly than people without diabetes," Deeb said.
But the report does provide detailed data on the intersecting effects of other risk factors, such as age and body mass index, he said. "You can tear the data apart and get intriguing things out of it," he added.
Deeb agreed with Antman that more effort is needed on the link between cardiac disease and diabetes. "We've got to be doing better than what we've been doing," he said. But when asked for a specific example of what needs to be done, he replied, "I'm not sure anybody knows."
Cooperation between cardiologists and the endocrinologists who treat diabetes is not always easy, because these are two distinct specialties, said Deeb, who is an endocrinologist.
He noted that the journal report did not include information that could be of interest to endocrinologists: "What was the effect of diabetes control on having a heart attack? What the report doesn't do is put diabetes control in there," Deeb said.
For more on the connection between diabetes and cardiovascular disease, visit the U.S. National Diabetes Information Clearinghouse.
SOURCES: Elliott A. Antman, M.D., senior investigator, Brigham and Women's Hospital, Boston; Larry C. Deeb, M.D., professor, pediatrics, University of Florida, Gainesville, and president, medicine and science, American Diabetes Association; Aug. 15, 2007,Journal of the American Medical Association