The name is absent



Nutrition and Coronary Heart Disease

been shown that diabetics have increased rates of CHD than поп-diabetics, and that this
relationship holds for both men and women14.

However, what is not clear is whether diabetes effect on CHD can be explained through
existing risk factors; plasma lipids and lipoproteins, blood pressure and obesity. The
following is an examination of the relation between diabetes, CHD and these other
known risk factors.

Diabetic patients have higher levels of total serum cholesterol than non-diabetics
(Rosengren et al, 1989 & De Leeus 1992). However, the relationship is more complex
and varies across IDDM and NIDDM (Winocour et al, 1992). With IDDM elevated
LDL appears to be to be the main Confounder for CHD (De Leeus, 1992). For NIDDM
it is a reduced HDL concentration and elevated VLDL (triglycerides) that partly explain
the relationship with CHD (Taskinen et al, 1982 & Laakso et al, 1993).

Diabetes is also linked to higher levels of blood pressure, which could partly explain its
relationship with CHD. The best evidence is supplied for systolic hypertension, but
only for IDDM and not NIDDM (Morrish, 1990). However, NIDDM is strongly
correlated with BMI, and its relationship with CHD could possibly be partly explained
through it (McKeigue et al, 1991).

Even when the relationship between CHD and diabetes is adjusted for the confounding
effects of known risk factors, diabetes remains a significant explanatory variable for
CHD (Kannel and McGee, 1979). A wide range Ofhaemorrheological anomolies may
act as the missing explanatory variable for the increased risk of CHD for diabetics (El-
Khawand et al, 1993 & Balkau et al (1993).

There has been some research into the possible harmful effects, in terms of increased
risk of CHD, of different diabetes treatments (UGPD, 1975). However, this relationship
will not be fully understood until the publication of the results from the United
Kingdom Prospective Diabetes Study (UKPDS)15.

'4 See Waller et al (1980), Vigorita et al (1980), Head et al (1990) and Garcia (1974).

'5 See UKPDS Group (1991) and http://www.drl.ox.ac.uk/Pages/UKPDS.html

CHERE Project Report 11 - November 1999

60




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