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(Circulation. 2008;117:1914-1917.)
© 2008 American Heart Association, Inc.

Editorial

Life and Death in Denmark

Lessons About Diabetes and Coronary Heart Disease

Allison B. Goldfine, MD; Joshua A. Beckman, MD

From the Joslin Diabetes Center (A.B.G.), Brigham and Women’s Hospital (A.B.G., J.A.B.), and Harvard Medical School (A.B.G., J.A.B.), all of Boston, Mass.

Correspondence to Allison B. Goldfine, MD, Joslin Diabetes Center, One Joslin Pl, Boston, MA 02215. E-mail Allison.Goldfine@Joslin. Harvard.Edu

Key Words: Editorials • diabetes mellitus • heart disease

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The prevalence of diabetes mellitus, primarily type 2 diabetes mellitus, is increasing at epidemic rates in the United States and worldwide, driven largely by increasing rates of obesity and advancing age for populations living in westernized countries. Diabetes mellitus is associated with a 2- to 4-fold increase in the risk of coronary heart disease, and among people with diabetes, about two thirds of deaths are due to cardiovascular disease, including ischemic heart disease, congestive heart failure, and stroke.¹ The increase in mortality for patients with diabetes mellitus after myocardial infarction is seen both acutely and in a sustained manner and holds true for both men and women. Indeed, many have suggested diabetes mellitus to be a coronary heart disease risk equivalent, because multiple studies have demonstrated that patients with diabetes but without prior cardiovascular disease have the same event rates as individuals without diabetes but with prior cardiovascular disease.^2,3 However, this suggestion has remained somewhat controversial, especially for patients at younger ages.^2,4,5

Article p 1945

Thus, to address whether diabetes mellitus accelerates the atherosclerotic process to such an extent that the presence of diabetes confers the same excess risk as that associated with prior myocardial infarction for the patient without diabetes, Schramm and colleagues,⁶ in the current issue of Circulation, report on the aggregate experience from the country of Denmark. All inhabitants of Denmark could be assessed with patient-level information through the Danish Civil Registration system, prescription drug use could be determined using The Danish Registry of Medicinal Product . . . [Full Text of this Article]