Risk Of Heart Disease In Patients Research Articles

Total Soluble and Endogenous Secretory Receptor for Advanced Glycation End Products as Predictive Biomarkers of Coronary Heart Disease Risk in Patients With Type 2 Diabetes

OBJECTIVECirculating levels of soluble receptor for advanced glycation end products (sRAGE) likely comprise both a secreted isoform (esRAGE) and wild-type RAGE cleaved from the cell membrane. Both sRAGE and esRAGE have been proposed as biomarkers of cardiovascular disease (CVD), but prospective data are limited. We examined the relationship of sRAGE and esRAGE to incident coronary heart disease (CHD) and stroke in type 2 diabetic patients followed for 3.9 years in a trial of atorvastatin: the Collaborative Atorvastatin Diabetes Study (CARDS).RESEARCH DESIGN AND METHODSWe used a nested case-control design sampling all incident cases of CVD with available plasma and randomly selecting three control subjects, who were free of CVD throughout follow-up, per case. Analysis was by Cox regression with adjustment for treatment allocation and relevant covariates.RESULTSsRAGE and esRAGE were strongly correlated (ρ = 0.88) and were both higher in those with lower BMI (P < 0.001), higher adiponectin (P < 0.001), lower estimated glomerular filtration rate (P = 0.009), and white ethnicity (P < 0.001). Both sRAGE and esRAGE were associated with incident CHD events, independently of treatment allocation and the above factors; hazard ratio (HR) = 1.74 (95% CI 1.25–2.41; P = 0.002) for a doubling of the sRAGE level; HR = 1.45 (1.11–1.89; P = 0.006) for a doubling of the esRAGE level. There was no significant association with stroke; HR for sRAGE = 0.66 (0.38–1.14). Atorvastatin, 10 mg daily, did not alter sRAGE.CONCLUSIONSHigher levels of sRAGE and esRAGE are associated with incident CHD but not stroke in type 2 diabetes.

Knowledge of heart disease risk in patients declining rehabilitation

Participation in cardiac rehabilitation programmes (CRPs) allows patients to increase their knowledge of the importance of established risk factors to help them maintain healthy lifestyle changes after coronary heart disease (CHD). To explore perceived importance and knowledge of known risk factors for CHD among non-attendees in CRPs. Consecutive non-attendees in CRPs (n=106) answered a questionnaire focusing on patients' attitudes towards risk factors and cardiac rehabilitation. The non-attendees lacked knowledge of non-physical characteristics such as depression and social isolation. They also had poor knowledge about biological causes and hereditary factors. However, those who said they knew enough about CHD to prevent recurrent illness did have sufficient knowledge about the established risk factors. There is a lack of knowledge about social isolation and depression and their importance in the development of CHD among the non-attendees. They show greater knowledge about biological risk factors than the importance of companionship, joy and happiness. CHD and loneliness are intimately correlated, so creating a sense of belonging must not be underestimated as a measure to prevent CHD.

P03-02 Prevalence of metabolic syndrome and coronary heart disease risk in patients with schizoaffective disorder: CLAMORS study

Aims:To assess the prevalence of metabolic syndrome (MS) and the coronary heart disease (CHD) risk in patients with schizoaffective disorder treated with antipsychotics.Methods:Schizoaffective patients from a multicentre cross-sectional study, in which 117 psychiatrists recruited consecutive outpatients meeting DSM-IV criteria for schizophrenia, schizophreniform or schizoaffective disorder and receiving antipsychotic treatment in monotherapy for at least 12 weeks. MS was defined as fulfilment of at least 3 of the following components (NCEP-ATP-III definition): waist circumference &gt;102(men)/&gt;88(women) cm; triglycerides &gt;=150mg/dL; HDL-cholesterol &lt; 40mg/dL(men)/&lt; 50mg/dL(women); blood pressure &gt;=130/85; fasting glucose &gt;=110mg/dL. CHD risk was assessed by SCORE (10-year CV death) and Framingham (10-year all CV events) functions.Results:268 valuable patients with schizoaffective disorder (127 men, 48.1%), 41.9±12.3 years (mean±SD) were examined. MS was presented in 26.5% (95%CI:21.2-31.8) of subjects [26.8% in men (19.1-34.5), 27.0% (19.6-34.4) in women (p=0.966)]. the overall 10-year CV risks (CV death or any event) were 0.8±1.6 (SCORE) and 6.5±6.8 (Framingham), respectively. the 8.4% (95%CI:5.0-11.8) and 20.1% (95%CI:15.2-24.9) of patients showed high/very-high risk according to SCORE (≥3%) and Framingham (≥10%), respectively. A high/very-high risk of any CV event (Framingham≥10%) was associated with age above 40(men)/45(women) years [OR: 32.44 (9.59-109.71, p&lt; 0.001)], and CGI-S=3-4; [OR: 4.32 (1.15-16.26, p=0.03)]. Women showed lower risk of any CV event [OR: 0.30 (0.14-0.65, p=0.002)].Conclusions:MS prevalence and CHD risk were high among patients with schizoaffective disorder treated with antipsychotics. Gender, age and poor disease control could be associated with CHD risk.*On behalf of the CLAMORS Collaborative Group.

Apolipoprotein CIII and Atherosclerosis

The prevailing concept of mechanisms responsible for the development of atherosclerotic lesions largely focuses on the accumulation and retention of low-density lipoproteins in the arterial intima and their subsequent oxidative modification. This oxidation leads to activation of the endothelium, and particularly, expression of adhesion molecules that mediate leukocyte adherence and chemokines which initiate the inflammation reaction that is widely accepted as being responsible for the development and progression of atherosclerotic lesions.1,2 There is also a strong body of evidence to indicate that elevated triacylglycerides (triglycerides) are an independent risk factor for atherosclerosis.3–5 Article p 731 One mechanism that can contribute to elevated triglycerides involves apolipoprotein CIII (apoCIII). apoCIII is a small protein that resides on the surface of very-low-density lipoproteins (VLDLs), low-density lipoproteins, chylomicrons, and high-density lipoproteins (Figure). It exists as multiple species, as either a nonglycosylated isoform (apoCIIIo) or a glycosylated isoform (apoCIII1 or apoCIII2); all three isoforms have similar plasma half-lives and probably have very similar physiological functions. Increased apoCIII production is a characteristic feature of patients with hypertriglyceridemia,6 and plasma apoCIII levels have been positively correlated with plasma triacylglycerol concentrations and also have been associated with severity of hypertriglyceridemia.7 Elevated plasma apoCIII concentration and, specifically, accumulation of apoCIII in triacylglycerol-rich lipoproteins is casually related to hypertriglyceridemia in patients with metabolic syndrome and has also been associated with insulin resistance.8 apoCIII is a major regulator of lipolysis, as it noncompetitively inhibits endothelial-bound lipoprotein lipase, the enzyme that hydrolyzes triacylglycerols in …

Haplotype of the angiotensinogen gene is associated with coronary heart disease in familial hypercholesterolemia

Familial hypercholesterolemia is characterized by high plasma low-density lipoprotein cholesterol levels and premature coronary heart disease. Despite the monogenetic origin of familial hypercholesterolemia, the incidence of coronary heart disease varies considerably among patients, which is only partly explained by classical risk factors. Hypertension is an important risk factor for coronary heart disease that is associated with angiotensinogen levels. Therefore, we analyzed the angiotensinogen gene as a modifier gene for coronary heart disease risk in patients with familial hypercholesterolemia. In a cohort of 1785 familial hypercholesterolemia patients, we reconstructed five frequent haplotypes of the angiotensinogen gene, based on four polymorphisms. The five haplotypes cover approximately 98% of the genetic diversity accounted for by these four polymorphisms. The associations between the haplotypes and coronary heart disease were analyzed with the haplo.stats program, adjusted for age, sex and smoking. Patients homozygous for the C allele of the 4072 T>C polymorphism had a 34% increased coronary heart disease risk (P = 0.017) compared to patients homozygous for the T allele. Haplotype H3, consisting of the minor allele of the 4072T>C polymorphism and the major alleles of the other polymorphisms, had a frequency of 15% and was associated with a 45% increased coronary heart disease risk (P = 0.006) compared to the wild-type haplotype H1. We conclude that genetic variation in the angiotensinogen gene contributes to coronary heart disease risk in patients with familial hypercholesterolemia.

Can a Chronic Care Model Collaborative Reduce Heart Disease Risk in Patients with Diabetes?

BackgroundThere is a need to identify effective practical interventions to decrease cardiovascular disease risk in patients with diabetes.ObjectiveWe examine the impact of participation in a collaborative implementing the chronic care model (CCM) on the reduction of cardiovascular disease risk in patients with diabetes.DesignControlled pre- and postintervention study.Patients/ParticipantsPersons with diabetes receiving care at 13 health care organizations exposed to the CCM collaborative and controls receiving care in nonexposed sites.Measurements and Main ResultsTen-year risk of cardiovascular disease; determined using a modified United Kingdom Prospective Diabetes Study risk engine score. A total number of 613 patients from CCM intervention sites and 557 patients from usual care control sites met the inclusion criteria. The baseline mean 10-year risk of cardiovascular disease was 31% for both the intervention group and the control group. Participants in both groups had improved blood pressure, lipid levels, and HbA1c levels during the observation period. Random intercept hierarchical regression models showed that the intervention group had a 2.1% (95% CI −3.7%, −0.5%) greater reduction in predicted risk for future cardiovascular events when compared to the control group. This would result in a reduced risk of one cardiovascular disease event for every 48 patients exposed to the intervention.ConclusionsOver a 1-year interval, this collaborative intervention using the CCM lowered the cardiovascular disease risk factors of patients with diabetes who were cared for in the participating organization’s settings. Further work could enhance the impact of this promising multifactorial intervention on cardiovascular disease risk reduction.

We-P11:108 The association of metabolic syndrome with novel markers of atherosclerosis potentiates coronary heart disease risk in patients with type 2 diabetes

We-P11:108 The association of metabolic syndrome with novel markers of atherosclerosis potentiates coronary heart disease risk in patients with type 2 diabetes

Combined Effect of the Metabolic Syndrome and Hostility on the Incidence of Myocardial Infarction (The Normative Aging Study)

A growing body of evidence suggests that the metabolic syndrome and hostility are independent risk factors for the development of coronary heart disease. However, few studies have examined the combined effect of the metabolic syndrome and hostility on the incidence of myocardial infarction (MI). We examined prospectively the relation among the metabolic syndrome, hostility, and the incidence of MI in healthy, older men (mean +/- SD 59.7 +/- 7.2 years) who participated in the Normative Aging Study. Seven hundred fifty-four men who were diagnosed as not having coronary heart disease and diabetes mellitus were included in the present study. Men were assigned to 1 of 4 risk-factor groups based on the presence or absence of the metabolic syndrome and low or high hostility. Hierarchical logistic regression was used to assess the multivariate risk of developing a MI. The incidence of MI was 11.3% (n = 85) over an average follow-up period of 13.8 years. After adjusting for potential covariates, risk-factor group significantly predicted the incidence of MI (odds ratio 1.59, 95% confidence interval 1.29 to 1.96, p <0.0001). The effect was strongest among patients who had the metabolic syndrome and high levels of hostility, with this subgroup showing a fourfold increase in the odds of developing a MI (odds ratio 4.21, 95% confidence interval 2.21 to 8.04, p = 0.0001). In conclusion, it appears that hostility may provide additional prognostic information to the assessment of coronary heart disease risk in patients with the metabolic syndrome and should routinely be evaluated as part of a comprehensive risk factor assessment.

The link between circulating markers of endothelial function and proteinuria in patients with primary glomerulonephritis

It is well established that there is an increase in the incidence of cardiovascular mortality in patients with proteinuric renal disease. The magnitude of the increase in risk is unlikely to be explained by traditional risk factors for cardiovascular disease alone. Proteinuria itself may constitute an additional risk factor, and proteinuric patients are known to have a degree of endothelial dysfunction. The nature of this relationship between proteinuria and endothelial function is the subject of intense investigation. The aim of this study was to examine the relationship between proteinuria and endothelial dysfunction, as reflected by serum von Willebrand factor (vWF), and the soluble cell adhesion molecules VCAM and ICAM, in patients with primary glomerulonephritis (GN). A secondary aim was to discern whether any relationship could be explained by renal function, lipid profile, inflammation or blood pressure. A cross-sectional study was undertaken in consecutive patients attending a general nephrology clinic with biopsy-proven primary GN. Patients with end-stage renal disease (ESRD), those on immunosuppressive drugs, or with intercurrent infective illnesses were excluded. Blood pressure and body mass index were recorded. Routine lab assays were undertaken for serum creatinine, lipid profile, and 24-hour urinary protein (U(Prot)). Additional serum samples were stored at -80 degrees C for subsequent measurement of vWF, VCAM, ICAM and sensitive C reactive protein (sCRP). Data were collected from 129 (86 male) patients. Mean (standard deviation) estimated creatinine clearance was 64 (32) ml/min, and median (interquartile range) 24-hour proteinuria was 1.1 (0.22-2.9) g. Mean vWF was 173 (68) IU/dl, median VCAM, ICAM and sCRP were 594 (410-708) ng/ml, 235 (208-286) ng/ml, and 2.33 (0.83-5.68) mg/l, respectively. There was a significant positive correlation between vWF and U(Prot) (Spearman rank correlation, r = 0.41, p < 0.001). When split into tertiles, according to U(Prot) (0-500 mg, 500-2000 mg, and > 2000 mg), there was a significant, stepwise increase in mean vWF (p < 0.001), log VCAM (p < 0.001), and log ICAM (p = 0.002). On multivariate analysis with vWF as the continuous dependent variable, U(Prot), age, total cholesterol and sCRP were the only significantly independent correlates (model-adjusted R2 = 33%). In patients with primary GN, there is a significant association between endothelial activation as reflected by vWF, VCAM, or ICAM and increasing proteinuria. Elevations in vWF, as well as being related to classical risk factors, are associated with increases in total proteinuria and low-grade inflammation. Thus, future prospective studies should examine the extent to which vWF and other circulating markers of endothelial activation predict coronary heart disease risk in patients with proteinuric renal disease.

Incidence, prevalence and coronary heart disease risk level in known Type 2 diabetes: a sentinel practice network study in the Basque Country, Spain

The aim of this study was to determine the incidence, prevalence and coronary heart disease risk in patients with known Type 2 (non-insulin-dependent) diabetes mellitus in a Basque Country sentinel practice network study. During the year 2000 we did a survey among sentinel practitioners who registered information about previously and newly diagnosed Type 2 diabetic patients older than 24 years of age. We studied 65,651 people attending a primary care service in the Basque Country Health Service-Osakidetza. We collected information about diabetic complications and cardiovascular risk factors and measured the coronary heart disease risk in these patients. In the year 2000, the standardized cumulative incidence and prevalence of known Type 2 diabetes were 5.0 per 1000 (CI 95%: 4.9-5.1) and 4.6% (CI 95%: 4.5-4.7) respectively. Macroangiopathy was the most frequent complication both in the newly diagnosed (21.6%) and previously known Type 2 diabetic patients (33%). Total cholesterol > or =5.17 mmol/l and LDL cholesterol > or =2.58 mmol/l were found in 75% and 90% of newly diagnosed and 65% and 85% of previously diagnosed Type 2 diabetic patients respectively. Of the Type 2 diabetic patients 42% were obese and 80% had high blood pressure. More than 55% of the men compared with 44% of the women with Type 2 diabetes had high or very high risk of coronary heart disease (p<0.05). We report new epidemiological data on known Type 2 diabetes in the Basque Country. These patients have a high frequency of cardiovascular risk factors causing a high coronary heart disease risk.

Evaluation and management of dyslipidemia in patients with HIV infection.

Persons with HIV infection develop metabolic abnormalities related to their antiretroviral therapy and HIV infection itself. The objective of this study was to summarize the emerging evidence for the incidence, etiology, health risks, and treatment of dyslipidemias in HIV disease. Systematic review of original research with quantitative synthesis. Dyslipidemia is common in persons with HIV infection on highly active antiretroviral therapy (HAART), but methodologic differences between studies preclude precise estimates of prevalence and incidence. The typical pattern includes elevated total cholesterol, low-density lipoprotein cholesterol, and triglycerides, which may be markedly elevated. The dyslipidemia may be associated with lipodystrophy, insulin resistance, and, rarely, frank diabetes mellitus. Exposure to protease inhibitors (PIs) is associated with this entire range of metabolic abnormalities. PI-naïve patients on nucleoside reverse transcriptase inhibitors (NRTIs) may develop lipodystrophy, insulin resistance, hypercholesterolemia, and possibly modest elevations in triglycerides but not severe hypertriglyceridemia, which appears to be linked to PIs alone. Most studies have not found an association between CD4 lymphocyte count or HIV viral load and lipid abnormalities. The pathogenesis is incompletely understood and appears to be multifactorial. There are insufficient data to definitively support an increased coronary heart disease risk in patients with HIV-related dyslipidemia. However, some of the same metabolic abnormalities remain firmly established risk factors in other populations. Patients on HAART with severe hypertriglyceridemia may develop pancreatitis or other manifestations of the chylomicronemia syndrome. Some of the metabolic derangements (particularly hypertriglyceridemia) may improve upon replacing a PI with a non-nucleoside reverse transcriptase inhibitor. The limited experience suggests that fibrates, pravastatin, and atorvastatin can safely treat lipid abnormalities in HIV-infected patients. Patients with HIV infection on HAART should be screened for lipid disorders, given their incidence, potential for morbidity, and possible long-term cardiovascular risk. Treatment decisions are complex and must include assessments of cardiac risk, HIV infection status, reversibility of the dyslipidemia, and the effectiveness and toxicities of lipid-lowering medications. The multiple potential drug interactions with antiretroviral or other HIV-related medications should be considered in lipid-lowering drug selection and monitoring.

Riesgo cardiovascular y metabolismo de la glucosa: acuerdos y discrepancias entre las clasificaciones OMS-85 y ADA-97

AIM. To identify the differences between coronary heart disease risk in patients with altered basal glucemia (ABG), oral glucose intolerance (OGI) and type II diabetes mellitus according to the WHO-85 and ADA-97 diagnostic classifications, in an adult population at high risk for diabetes mellitus. Descriptive, cross-sectional, multicenter study.Setting. Seven primary health care centers in Spain.Patient. 970 persons considered the population at risk for type II diabetes mellitus. Participants were classified according to the criteria of the WHO-85 (normal, OGI, diabetes) and the ADA-97 system (normal, ABG, diabetes). The following variables were recorded: age, sex, smoking habit, body mass index, systolic blood pressure, diastolic blood pressure, basal glucemia, glucemia 2 h after an oral glucose tolerance test, HbA1c, microalbmuniuria, total cholesterol, HDL, LDL and triglycerides. Coronary heart disease risk was calculated with the 1998 table developed by Wilson et al. on the basis of the Framingham study. A total of 970 participants were studied. Mean age was 58.6 #+ 12.4 years; 453 were men (46.7%) and 517 were women (53.3%). Our analysis showed that cardiovascular disease risk factors were less frequent in normal subjects, and that their prevalence was higher in persons with diabetes (according to both WHO and ADA classifications). There were no significant differences in coronary heart disease risk or different risk factors between analogous groups in the two classification systems (normal, OGI/ABG or diabetes). Coronary heart disease risk in persons with different types of alterations in glucose metabolism was 11.3% in normal subjects, 14% in persons with OGI and 27.3% in persons with diabetes according to the WHO-85 system, and 11.4% in normal subjects, 15.7% in persons with ABG and 29.5% in persons with diabetes according to the ADA-97 system. The greater the alteration in carbohydrate metabolism, the greater the coexistence of risk factors and the estimated risk of coronary heart disease. There were no significant differences in the presence of cardiovascular risk factors, or in the relationship between carbohydrate metabolism and coronary heart disease risk, between analogous stages identified with one classification system or the other.

Internet dietary management system is an effective adjunct to medical nutrition therapy for lowering weight, glucose, triglyceride, and coronary heart disease risk in patients with metabolic syndrome X

Internet dietary management system is an effective adjunct to medical nutrition therapy for lowering weight, glucose, triglyceride, and coronary heart disease risk in patients with metabolic syndrome X

Effect of orlistat-assisted weight loss in decreasing coronary heart disease risk in patients with syndrome X

This study describes the changes in risk factors for coronary heart disease in obese persons with syndrome X after orlistat-assisted weight loss. Data were available for 1,700 patients who completed 52 weeks of weight loss; 128 were defined as having syndrome X by being in the quintile with the highest plasma triglyceride levels (>2.2 mM/L) and the lowest high-density lipoprotein cholesterol (HDL, <1.0 mM/L) concentrations. Initial characteristics of those with syndrome X were similar to the 119 subjects (non-syndrome X) in the lowest quintile of plasma triglyceride (<0.975 mM/L) and highest quintile of HDL cholesterol (>1.5 mM/L). Subjects were placed on a calorie-restricted diet, and randomized to receive orlistat or placebo. Initial values were higher in those with syndrome X for diastolic blood pressure (p = 0.03), plasma insulin (p = 0.0001), triglyceride (p = 0.0001) concentrations, and ratio of low-density lipoprotein cholesterol to HDL cholesterol (p = 0.0001), and were lower for HDL cholesterol (p = 0.001) concentrations. Weight loss was greater in both groups of orlistat-treated patients (p = 0.026); in those with syndrome X, it was associated with a significant reduction in plasma insulin (p = 0.019) and triglyceride (p = 0.0001) concentrations, an increase in HDL cholesterol concentration, and a decrease in low-density lipoprotein/HDL cholesterol ratio (p = 0.0001). There were no significant changes in plasma insulin, triglycerides, or HDL cholesterol concentration in the non-syndrome X group. In conclusion, weight loss attenuates coronary heart disease risk factors in obese persons with syndrome X, and the risk factor reduction is enhanced with administration of orlistat.

An Easier Approach to Estimating Risk of Coronary Heart Disease and Stroke

To the Editor: In their article, Wilson et al1 provide useful information that allows clinicians to predict coronary heart disease risk in patients without a history of heart disease. This is very much needed because primary care and specialty physicians typically overestimate patients’ absolute heart disease risk and the expected benefits of drug therapy given for primary prevention.2 3 To encourage …

S.21.02 Evaluation of D3 receptor antagonists

T cell infiltration has been associated with increased coronary heart disease risk in patients with diabetes mellitus. Effect of modulation of T cell trafficking on diabetes-induced cardiac fibrosis has yet to be determined. Therefore, our aim was to investigate the circulatory T cell depletion-mediated cardioprotection in streptozotocin-induced diabetic cardiomyopathy. Fingolimod (FTY720), an immunomodulatory drug, was tested in wild-type (WT) C57BL/6 and recombination activating gene 1 (Rag1) knockout (KO) mice without mature lymphocytes in streptozotocin-induced type 1 diabetic model. FTY720 (0.3 mg/kg/day) was administered intraperitoneally daily for the first 4 weeks with interim 3 weeks then resumed for another 4 weeks in 11 weeks study period. T lymphocyte counts, cardiac histology, function, and fibrosis were examined in diabetic both WT and KO mice. FTY720 reduced both CD4+ and CD8+ T cells in diabetic WT mice. FTY720-treated diabetic WT mouse myocardium showed reduction in CD3 T cell infiltration and decreased expression of S1P1 and TGF-β1 in cardiac tissue. Fibrosis was reduced after FTY720 treatment in diabetic WT mice. Rag1 KO mice exhibited no CD4+ and CD8+ T cells in the blood and CD3 T cells in the heart. Diabetic Rag1 KO mouse hearts appeared no fibrosis and exhibited preserved myocardial contractility. FTY720-induced antifibrosis was abolished in diabetic Rag1 KO mice. These findings demonstrate that chronic administration with FTY720 induces lymphopenia and protects diabetic hearts in WT mice whereas FTY720 increases cardiac fibrosis and myocardial dysfunction in diabetic Rag1 KO mice without mature lymphocytes.

Will correction of dyslipoproteinaemia reduce coronary heart disease risk in patients with non-insulin-dependent diabetes? Need for trial evidence.

The incidence of atherosclerotic vascular disease is greatly increased in patients with non-insulin-dependent diabetes (NIDDM). The most frequent lipoprotein abnormalities in this type of diabetes are an increase in triglyceride-rich lipoproteins and a decrease in high-density lipoproteins. Hypertriglyceridaemia appears to be a stronger coronary heart disease risk factor in patients with NIDDM than in nondiabetic subjects. Plasma total and low-density lipoprotein cholesterol levels in NIDDM patients and nondiabetic subjects do not differ. Hypercholesterolaemia is, however, as powerful a predictor of coronary heart disease risk in diabetic patients as in nondiabetic subjects. In spite of this knowledge, there is to date no solid evidence to indicate whether correction of dyslipoproteinaemia in order to reduce coronary heart disease risk in patients with NIDDM is more, equally, or less beneficial than it is in nondiabetic subjects. The only available data come from post-hoc subgroup analyses of the Helsinki Heart Study and the Scandinavian Simvastatin Survival Study (4S). Other trials including patients with diabetes are in progress. Only one intervention trial (currently in its treatment phase), the Diabetes Atherosclerosis Intervention Study (DAIS), is specifically designed to examine the lipid hypothesis in patients with NIDDM.