Prevalence of multiple cardiac risk factors in US adults with diabetes

Purpose: The National Cholesterol Education Program, Adult Treatment Panel III ( NCEP ATP III) included diabetes mellitus ( DM) as a risk factor for major coronary events equivalent to existing coronary heart disease ( CHD). This study estimates the national prevalence of additional CHD risk factors for US adults with and without DM and heart disease using Medical Expenditure Panel Survey ( MEPS) data. Methods: In this retrospective study using nationally representative 2000 and 2002 MEPS survey data, DM and CHD for adult respondents ( n = 44 481) were identified by ICD-9 codes or self-reported DM, coronary heart disease, angina, heart attack or stroke, or other heart disease. Six additional risk factors assessed were hypertension, hypercholesterolemia, smoking, age (= 45 years [ men], = 55 years [ women]), obesity, and physical inactivity. The national prevalence of cardiac risk factors was assessed in four subgroups: CHD-/DM-; CHD-/DM+; CHD+/DM-, CHD+/DM+. Results: The CHD-/DM+ group had significantly higher mean risk factor counts than did the CHD-/DM- group and the CHD+/DM- group ( 2.6 versus 1.4 and 2.4, respectively; both p < 0.01). The CHD+/DM+ group had the highest mean risk factor count at 3.4. Proportions of US adults in each subgroup with two or more risk factors were CHD-/DM-: 39.5%; CHD-/DM+: 81.9%; CHD+/DM-: 74.9%; CHD+/DM+: 95.1%. Limitations of this study include the use of self-reported data and the lack of data regarding family history of CHD, both of which are likely to result in conservative prevalence estimates. Conclusion: Results presented here indicate that diabetes, with or without co-morbid heart disease, is associated with a high prevalence of cardiac risk factors in US adults. The prevalence estimates reported here demonstrate the extensiveness of this public health issue. It is essential that medical providers treat modifiable risk factors in patients with diabetes aggressively with lifestyle modifications and pharmacotherapy consistent with NCEP ATP III recommendations.