Effects of Diabetes and Level of Glycemia on All-Cause and Cardiovascular Mortality: The San Antonio Heart Study

OBJECTIVE: Although the level of hyperglycemia is clearly a risk factor for microvascular complications in diabetic patients, its role in macrovascular complications remains controversial. We followed 4,875 subjects (65% Mexican-American) for 7-8 years to investigate the effects of diabetes and hyperglycemia on all-cause and cardiovascular disease (CVD) mortality. These end points were also analyzed according to quartiles of baseline fasting plasma glucose among diabetic participants. RESEARCH DESIGN AND METHODS: The Cox proportional hazards model was used to estimate the relative risks (RRs) for all-cause and CVD mortality. RESULTS: Diabetes was significantly associated with increased all-cause mortality (RR 95% CI = 2.1 1.3-3.5 in men; 3.2 1.9-5.4 in women) and increased CVD mortality (3.2 1.4-7.1 in men; 8.5 2.8-25.2 in women). Among diabetic subjects, those in quartile 4 had a 4.2-fold greater risk of all-cause mortality (P 6.2 mmol/l were significant predictors of CVD mortality using Cox models. CONCLUSIONS: We conclude that diabetes is a predictor of both all-cause and CVD mortality in the general population and that both hyperglycemia and common CVD risk factors are important predictors of all-cause and CVD mortality in diabetic subjects.