Key result
Diabetes confers a similar ~2.4-fold higher risk of CV death as prior MI in men.
Why the study?
Previous studies showed major differences and uncertainty in estimated cardiovascular risk in diabetes mellitus, especially in young patients, necessitating large studies of well-defined populations.
Does diabetes requiring glucose-lowering therapy confer a similar risk of cardiovascular death compared to a prior myocardial infarction in adults ≥30 years of age?
Cohort
Does diabetes requiring glucose-lowering therapy confer a similar risk of cardiovascular death compared to a prior myocardial infarction in adults ≥30 years of age?
Patients aged ≥30 years requiring glucose-lowering therapy for diabetes exhibit a cardiovascular risk comparable to nondiabetics with a prior myocardial infarction, supporting the concept of diabetes as a coronary heart disease risk equivalent.
Supports diabetes as CHD risk equivalent in men; hypothesis-generating for equivalent management without randomized confirmation.
BACKGROUND: Previous studies reveal major differences in the estimated cardiovascular risk in diabetes mellitus, including uncertainty about the risk in young patients. Therefore, large studies of well-defined populations are needed. METHODS AND RESULTS: All residents in Denmark > or = 30 years of age were followed up for 5 years (1997 to 2002) by individual-level linkage of nationwide registers. Diabetes patients receiving glucose-lowering medications and nondiabetics with and without a prior myocardial infarction were compared. At baseline, 71 801 (2.2%) had diabetes mellitus and 79 575 (2.4%) had a prior myocardial infarction. Regardless of age, age-adjusted Cox proportional-hazard ratios for cardiovascular death were 2.42 (95% confidence interval [CI], 2.35 to 2.49) in men with diabetes mellitus without a prior myocardial infarction and 2.44 (95% CI, 2.39 to 2.49) in nondiabetic men with a prior myocardial infarction (P=0.60), with nondiabetics without a prior myocardial infarction as the reference. Results for women were 2.45 (95% CI, 2.38 to 2.51) and 2.62 (95% CI, 2.55 to 2.69) (P=0.001), respectively. For the composite of myocardial infarction, stroke, and cardiovascular death, the hazard ratios in men with diabetes only were 2.32 (95% CI, 2.27 to 2.38) and 2.48 (95% CI, 2.43 to 2.54) in those with a prior myocardial infarction only (P=0.001). Results for women were 2.48 (95% CI, 2.43 to 2.54) and 2.71 (95% CI, 2.65 to 2.78) (P=0.001), respectively. Risks were similar for both diabetes types. Analyses with adjustments for comorbidity, socioeconomic status, and prophylactic medical treatment showed similar results, and propensity score-based matched-pair analyses supported these findings. CONCLUSIONS: Patients requiring glucose-lowering therapy who were > or = 30 years of age exhibited a cardiovascular risk comparable to nondiabetics with a prior myocardial infarction, regardless of sex and diabetes type. Therefore, requirement for glucose-lowering therapy should prompt intensive prophylactic treatment for cardiovascular diseases.
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Schramm et al. (2008) conducted a cohort in Diabetes mellitus. Diabetes mellitus requiring glucose-lowering therapy (without prior myocardial infarction) vs. Nondiabetics without a prior myocardial infarction was evaluated on Cardiovascular death (HR 2.42, 95% CI 2.35-2.49, p=0.60). Diabetes requiring glucose-lowering therapy conferred a similar risk of cardiovascular death as a prior myocardial infarction in nondiabetic men (HR 2.42 vs 2.44; P=0.60).
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