Published Online
on March 31, 2008

A more recent version of this article appeared on April 15, 2008

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Submitted on June 12, 2007
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^*, Gunnar H. Gislason MD, Lars Køber MD, DMSc, Søren Rasmussen MSc, PhD, Jeppe N. Rasmussen MD, PhD, Steen Z. Abildstrøm MD, PhD, Morten Lock Hansen MD, Fredrik Folke MD, Pernille Buch MD, Mette Madsen MSc, Allan Vaag MD, DMSc, and Christian Torp-Pedersen MD, DMSc

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 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.

Conclusions—Patients requiring glucose-lowering therapy who were 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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