Key result
Diabetes alone is linked to ~23% lower MACE risk than CHD alone but higher overall mortality.
Why the study?
Since the introduction of statins and contemporary preventive strategies, it was unclear whether diabetes and coronary heart disease still confer similarly high cardiovascular risk.
Does diabetes alone confer a similar cardiovascular risk as coronary heart disease alone in a contemporary cohort?
Cohort (n=1,116,456)
Does diabetes alone confer a similar cardiovascular risk as coronary heart disease alone in a contemporary cohort?
Hazard Ratio: 0.77 (95% CI 0.74–0.78)
Absolute Event Rate: 10.8% vs 19.7%
In a contemporary cohort, diabetes alone does not carry the same coronary or cardiovascular risk as CHD alone, challenging the historical concept of diabetes as a strict CHD risk equivalent, though it is associated with higher non-coronary vascular events and all-cause mortality.
Supports distinguishing diabetes from CHD in MACE risk assessment; leaves open explanations for excess mortality.
Background In the pre-statin era, diabetes posed a similar cardiovascular risk as previous myocardial infarction in patients without diabetes. Since the development of statins, several primary preventive treatment strategies have been introduced. We investigated whether diabetes and coronary heart disease (CHD) confer similarly high cardiovascular risk in a semi-nationwide contemporary cohort. Methods We included all individuals aged 50–89 residing in Western Denmark on January 1, 2012. Participants were categorized into four groups: diabetes alone, CHD alone, both diabetes and CHD, and neither condition. CHD was defined as previous myocardial infarction, coronary revascularization, or documented coronary artery disease. Participants were followed for up to seven years for major adverse cardiovascular events (MACE), coronary events (myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting), non-coronary vascular events (ischemic stroke, lower limb revascularization, or amputation), and all-cause mortality. Findings We included 1,116,456 people residing in Western Denmark on January 1, 2012. Of these, 7.5% (84,186/1,116,456) had diabetes alone; 5.0% (55,072/1,116,456) had CHD alone. Diabetes alone, compared with CHD alone, was associated with lower seven-year rates of MACE (10.8% versus 19.7%, adjusted hazard ratio (HR) 0.77, 95% CI 0.74–0.78) and coronary events (6.1% versus 16.0%, adjusted HR 0.46, 95% CI 0.44–0.48), but higher rates of non-coronary vascular events (9.4% versus 9.9%, adjusted HR 1.27, 95% CI 1.22–1.32) and all-cause mortality (25.6% versus 30.6%, adjusted HR 1.31, 95% CI 1.28–1.33). Interpretation Diabetes alone does not carry the same coronary or cardiovascular risk as CHD alone, but it is associated with increased rates of non-coronary vascular events and all-cause mortality. Funding This study was funded by the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
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Olesen et al. (2026) conducted a cohort in Diabetes and Coronary Heart Disease (n=1,116,456). Diabetes alone vs. Coronary heart disease (CHD) alone was evaluated on Major adverse cardiovascular events (MACE) (HR 0.77, 95% CI 0.74-0.78). Diabetes alone, compared with CHD alone, was associated with a lower seven-year rate of MACE (10.8% vs 19.7%; HR 0.77, 95% CI 0.74-0.78) but higher all-cause mortality.
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