The disease that affects more than 16 million Americans has topped the list as an independent risk factor for coronary heart disease. Diabetes climbed to the top of the list as a result of the prevalence of multiple risk factors associated with the disease which include insulin resistance, hypertension, and lipid and clotting abnormalities, said Dr. Abhimanyu Garg, professor of internal medicine and a senior investigator in the Center for Human Nutrition.

Diabetes was at the bottom of the list for some time, and there was not much emphasis given to the disease as a risk factor for heart disease, he said. Information from recent studies reveals that:

• Diabetics have an unusually higher risk of dying from a first heart attack than individuals without heart disease.
  
  
• Diabetics have the same risk for a heart attack or of developing coronary heart events as individuals with pre-existing coronary heart disease.
  
  
• At least one-fifth of diabetics may develop heart disease in the next 10 years, Dr. Garg said, adding that the proper treatment for diabetics should be expanded.

Not all physicians who treat diabetics have been paying attention to cholesterol, he said. My hope is that these new guidelines will cause primary-care physicians to move in the right direction and treat glucose levels, as well as blood cholesterol levels, in diabetic patients. Type 2 diabetes, or non-insulin-dependent diabetes mellitus, is the most common type of diabetes, affecting more than 14 million Americans. Type 1 diabetes, which is sometimes referred to as juvenile-onset diabetes, accounts for 5 percent to 10 percent of all diagnosed cases of diabetes. Other types of diabetes occur as a result of genetic syndromes, pancreatic disease, endocrine disorders, drugs, infections and other illnesses and account for 1 percent to 2 percent of all diagnosed cases. Gestational diabetes affects about 4 percent of all pregnant women.

The diabetes risk equivalent factor for coronary heart disease is specific for type 2 diabetics, Dr. Garg said. He added that patients with type 1 diabetes also are at high risk. Not only is diabetes an independent risk factor for coronary heart disease, it is also a major contributor to several other serious health problems, such as blindness, kidney disease and amputations.

The prevalence of diabetes is rising in the United States. Type 2 diabetes, which is more prevalent in middle-aged adults, is now showing up in children and adolescents, Dr. Garg said. These trends are alarming. There is an urgent need to develop strategies to prevent type 2 diabetes. To successfully turn the tide, he recommends placing an emphasis on diet, weight reduction and diabetes control. Effective means of reducing cholesterol should be utilized to the maximum. Adding diabetes as an independent risk factor and implementing aggressive cholesterol management in diabetic patients is a step in the right direction, he said.