Key result
Type 2 diabetes without significant CAD was associated with a lower vascular event rate than nondiabetic patients with significant CAD (8.0% vs 24.9%, P=0.008).
Why the study?
Does the presence of Type 2 diabetes without significant CAD confer the same risk of future vascular events as established significant CAD?
Cohort (n=750)
Does the presence of Type 2 diabetes without significant CAD confer the same risk of future vascular events as established significant CAD?
Type 2 diabetes without significant coronary atherosclerosis does not carry the same risk for future vascular events as established CAD, challenging the paradigm that diabetes is universally a CAD risk equivalent.
Answers are grounded in this paper and cite their sources.
Diabetes without significant CAD may not equate to CAD risk; challenges risk-equivalent paradigm and leaves open prospective validation.
BACKGROUND: Current guidelines consider diabetes per se as a coronary artery disease (CAD) risk equivalent. We aimed at investigating the contribution of baseline coronary atherosclerosis to the risk of diabetic patients for future vascular events. DESIGN: Prospective cohort study. METHODS: Vascular events were recorded over 4 years in 750 consecutive patients undergoing coronary angiography for the evaluation of stable CAD. RESULTS: From our patients, 244 had neither type 2 diabetes (T2DM) nor significant CAD (i.e. coronary stenoses >or=50%) at the baseline angiography, 50 had T2DM but not significant CAD, 342 did not have T2DM but had significant CAD, and 114 had both T2DM and significant CAD. Nondiabetic patients without significant CAD had an event rate of 9.0%. The event rate was similar in T2DM patients without significant CAD (8.0%, P = 0.951), but higher in nondiabetic patients with significant CAD (24.9%, P<0.001). Patients with T2DM and significant CAD had the highest event rate (43.0%). Importantly, T2DM patients without significant CAD had a significantly lower event rate than nondiabetic patients with significant CAD (P = 0.008). CONCLUSION: T2DM per se is not a CAD risk equivalent. Moderate-risk diabetic patients without significant CAD and very high-risk diabetic patients with significant CAD add up to a grand total of high-risk diabetic patients, this is why diabetes seems to be a CAD risk equivalent in many epidemiological studies.
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Saely et al. (2010) conducted a cohort in Stable coronary artery disease (n=750). Type 2 diabetes without significant CAD vs. Nondiabetic patients with significant CAD was evaluated on Vascular events (p=0.008). Type 2 diabetes without significant CAD was associated with a lower vascular event rate than nondiabetic patients with significant CAD (8.0% vs 24.9%, P=0.008).
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