Diabetes é um fator de risco conhecido de doenças cardiovasculares. Foi por muito tempo utilizado, inclusive em guidelines de dislipidemia, como equivalente de doença coronariana e automaticamente classificando seu portador como tendo alto risco cadiovascular (RCV), independentemente da idade do doente ou tempo da doença.
Guidelines mais recentes recomendam avaliação individualizada do RCV (apesar de haver controvérsia da melhor forma de se calcular esse risco - Framingham? ASCVD - Pooled Cohort Equation?).
De forma geral, após 10 anos de diabetes, esse estudo demonstrou que o RCV torna-se similar.
| Diabetes as a coronary risk equivalent |
Diabetes mellitus (DM) is frequently referred to as a "coronary risk equivalent," meaning that the risk of a coronary heart disease (CHD) event is similar between individuals with DM and individuals with known CHD. However, this “equivalency” averages together patients with widely varying CHD risks, and many patients with DM have much lower risks. This was examined in a prospective cohort study that followed more than 1.5 million adults (ages 30 to 90) for a median of 9.9 years [3]. The rate of new CHD events was lower 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 only in patients who had DM for more than 10 years.
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| Rana JS, Liu JY, Moffet HH, et al. Diabetes and Prior Coronary Heart Disease are Not Necessarily Risk Equivalent for Future Coronary Heart Disease Events. J Gen Intern Med 2016; 31:387. |
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