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(Circulation. 2004;109:855-860.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

Cardiovascular Events in Diabetic and Nondiabetic Adults With or Without History of Myocardial Infarction

Chong Do Lee, EdD; Aaron R. Folsom, MD; James S. Pankow, PhD; Frederick L. Brancati, MD, For the Atherosclerosis Risk in Communities (ARIC) Study Investigators

From the Department of Sports and Exercise Sciences (C.D.L.), West Texas A&M University, Canyon, Tex; Division of Epidemiology (A.R.F., J.S.P.), School of Public Health, University of Minnesota, Minneapolis, Minn; and Departments of Medicine and Epidemiology (F.L.B.), Johns Hopkins University, Baltimore, Md.

Correspondence to Dr Aaron Folsom, Division of Epidemiology, School of Public Health, University of Minnesota, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454-1015. E-mail folsom{at}epi.umn.edu

Received July 15, 2003; de novo received October 14, 2003; accepted November 21, 2003.

Background— Whether diabetic patients without a history of myocardial infarction (MI) have the same risk of coronary heart disease (CHD) events as nondiabetic patients with a history of MI remains controversial. We compared risks of CHD and stroke events and mortality from cardiovascular disease (CVD) in diabetic and nondiabetic men and women with and without a history of MI.

Methods and Results— We followed a total of 13 790 African American and white men and women ages 45 to 64 years who participated in the Atherosclerosis Risk in Communities study, beginning in 1987 to 1989. There were 634 fatal CHD or nonfatal MI events, 312 fatal or nonfatal strokes, and 358 deaths from CVD during an average of 9 years of follow-up (125 998 person-years). After adjustment for age, sex, race, Atherosclerosis Risk in Communities field center, and multiple baseline risk factors, patients who had a history of MI without diabetes at baseline had 1.9 times the risk of fatal CHD or nonfatal MI (95% CI, 1.35 to 2.56; P<0.001) compared with diabetic patients without a prior history of MI. The nondiabetic patients with MI also had 1.8 times the risk of CVD mortality compared with diabetic patients without MI (95% CI, 1.22 to 2.72; P=0.003). However, stroke risk was similar between diabetic patients without MI and nondiabetic patients with MI (RR, 1.05; 95% CI, 0.61 to 1.79; P=0.87). We also observed that nondiabetic patients with MI had a carotid artery wall thickness similar to diabetic patients without MI (P=0.77).

Conclusions— Diabetic patients without MI had lower risk of CHD events and mortality from CVD compared with nondiabetic patients with MI, but stroke risk was similar between these 2 groups.

Key Words: diabetes mellitus • myocardial infarction • stroke • cardiovascular diseases

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