on March 31, 2008
Published online before print March 31, 2008, doi: 10.1161/CIRCULATIONAHA.107.720847
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Submitted on June 12, 2007
From the Department of Cardiology, Gentofte University Hospital, Hellerup (T.K.S., G.H.G., S.Z.A., M.L.H., F.F., P.B., C.T.-P.); National Institute of Public Health, Copenhagen (T.K.S., G.H.G., S.R., J.N.R., S.Z.A.); Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen (L.K.); Department of Public Health, University of Copenhagen, Copenhagen (M.M.); and Steno Diabetes Center, Gentofte (A.V.), Denmark. * To whom correspondence should be addressed. E-mail: tks{at}heart.dk.
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 Conclusions—Patients requiring glucose-lowering therapy who were
Accepted on January 22, 2008
Diabetes Patients Requiring Glucose-Lowering Therapy and Nondiabetics With a Prior Myocardial Infarction Carry the Same Cardiovascular Risk. A Population Study of 3.3 Million People
Tina Ken Schramm MD*,
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.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.
Key words: cardiovascular diseases • coronary disease • diabetes mellitus • epidemiology • mortality • prognosis • stroke
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Circulation 2008 117: 1909.[Full Text]
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