One of the study included estimation of 23 biomarkers to improve prediction of CV risk in 1002 T2DM subjects from SMART and EPIC-NL study. Role of various emerging non-traditional novel CV risk factors has been widely studied in the development of CVD among diabetics. Along with pharmacological management, therapeutic lifestyle change with behaviour modification, self-management support and long term follow up for control of glycemic status and CV risk is required. This includes control of hypertension, use of aspirin and lipid lowering drugs depending upon CV risk score. 6 This emphasizes the significance of aggressive management of non-glycemic cardiovascular risk factors along with glycemic control. In this cohort, estimated CV risk correlated with lipid profile and microvascular complications, but weakly glycemic control. They estimated CV risk by recording variables age, sex, blood pressure, duration of diabetes, body mass index, lipid profile parameters, fasting and postprandial blood glucose levels, HbA1c, microalbuminuria, fundoscopy and presence or absence of diabetic foot among 1382 T2DM participants. 5 Brazilian study reported high risk of CHD (>20% in 10years) and risk more among males in comparison with females. This signifies the importance of duration of diabetes, glycemic status and presence of atrial fibrillation in risk stratification of T2DM patients. They observed 10year coronary risk was more with UKPDS engine than REGICOR equation scale (15.7+/-8.4% versus 5.8+/-2.5% respectively). UKPDs risk engine included age, sex, ethnic group, systolic blood pressure, smoking, duration of diabetes, total cholesterol, HDL, glycosylated haemoglobin (HbA1c) and presence of atrial fibrillation. REGICOR equation included variables sex, age, presence or absence of T2DM, smoking, systolic a diastolic blood pressures, total cholesterol and high density cholesterol levels for risk assessment. 5 compared coronary risk in Spanish T2DM subjects using Spanish scale REGICOR and UKPDS risk engines. Study from Sri lanka observed significant discrepancy between WHO/ISH and UKPDS risk engines and poor sensitivity of both among diabetics. But this tool excluded very important major risk factors- diastolic blood pressure and low-density lipoproteins (LDL). 3 For south Asian people, world health organization/ International society of Hypertension (WHO/ISH) tool was designed which included five parameters- age, sex, systolic blood pressure, smoking, and total cholesterol. UK Prospective Diabetes Study (UKPDS) is a diabetes-specific risk engine, which incorporated duration of DM and glycemic control along with traditional cardiac risk factors. But this scale, because of inclusion of variable presence of T2DM, which is proposed as CAD equivalent, could not be found useful for diabetics. FRS was the first tool used to predict next 10year risk of CAD based on findings from Framingham study of Caucasians participants. During past two decades various risk tools were developed by the researchers to stratify T2DM patients’ cardiovascular risk using various traditional CV risk factors. But recently it has been stated that FRS cannot be used to stratify cardiovascular (CV) risk of diabetics because T2DM itself is a coronary disease equivalent. 2 Framingham risk score (FRS) calculator is widely used and most popular tool to predict 10year cardiovascular risk. They remain undiagnosed because of silent ischemia and present with extensive diffuse damage to coronary arteries leading to poor long-term outcome. T2DM patients are at high risk of developing CAD at an earlier age than non-diabetic counterparts. Cardiovascular risk stratification of diabetics has also prognostic significance during management of CVD events. Precise risk assessment will help the clinicians to target the high-risk populations with most appropriate preventive measures. T2DM and CVD, both are chronic metabolic disorders sharing common multiple risk factors. Hence even if individuals with T2DM are at higher risk of developing cardiovascular complications, their risk stratification plays important role in therapeutic modifications in their management. 1 A coronary artery disease is the leading cause of morbidity and mortality among T2DM patients. Their risk of developing cardiovascular disease (CVD) is equivalent to non-diabetics with previous CAD. T2DM individuals are at two to six times’ high risk of coronary artery disease (CAD) and stroke than non-diabetics. With rising prevalence of type 2 Diabetes Mellitus (T2DM), burden of cardiovascular diseases is also rising at rapid pace.
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