Diabetes and Long-Term Risk of Mortality From Coronary and Other Causes in Middle-Aged Swedish Men: A general population study

OBJECTIVE: To assess the relation between cardiovascular risk factors and long-term cause-specific mortality risk in middle-aged diabetic men, compared with men without diabetes. RESEARCH DESIGN AND METHODS: This prospective study analyzes a large random population sample of men over a follow-up of 16 years. At baseline in 1974-1977, 249 men with diabetes and 6,851 men without diabetes, all aged 51-59 years, were identified. There were 2,126 deaths, 724 of which were due to coronary heart disease (CHD) and 1,001 deaths were due to any cardiovascular disease (CVD) cause. RESULTS: After adjustment for age, serum cholesterol, systolic blood pressure, smoking, BMI, and coronary disease at baseline, the relative risk of dying from any cause was 2.50 (95% CI, 2.11-2.95) in men with diabetes, compared with nondiabetic men, and 2.87 (2.31-3.57) for cardiovascular death. Men with diabetes had no significant excessive risk of dying from cancer or violent causes, but the relative risk of dying from any other noncardiovascular cause was 3.69 (2.55-5.34). Most of these deaths were due to diabetes and its complications. Hypercholesterolemia, smoking, and elevated systolic blood pressure predicted both coronary and all-cause mortality in diabetic as well as in nondiabetic men. Men with diabetes and serum cholesterol > 7.2 mmol/l had a risk of dying from coronary disease of 45.3 and from any cause of 76.1 per 1,000 observation-years. In men with diabetes, the relative risk of dying associated with serum cholesterol > 7.2 mmol/l, as compared with < 5.2 mmol/l, was 1.78 (95% CI, 1.05-3.02). The corresponding risk for nondiabetic men was 1.23 (1.04-1.46), and there was a statistically significant interaction between serum cholesterol and diabetes (P = 0.004). CONCLUSIONS: In men with diabetes, hypercholesterolemia, smoking, and hypertension predict coronary mortality risk, as well as mortality risk from all causes. Men with both diabetes and hypercholesterolemia have severely compromised survival and should be targeted for intervention aimed at lowering their lipid levels.