Long-Term Cardiovascular Risk in Type 2 Diabetic Compared With Nondiabetic First Acute Myocardial Infarction Patients

OBJECTIVE The aim of this study was to determine whether long-term cardiovascular risk differs in type 2 diabetic patients compared with first acute myocardial infarction patients in a Mediterranean region, considering therapy, diabetes duration, and glycemic control. RESEARCH DESIGN AND METHODS A prospective population-based cohort study with 10-year follow-up was performed in 4,410 patients aged 30–74 years: 2,260 with type 2 diabetes without coronary heart disease recruited in 53 primary health care centers and 2,150 with first acute myocardial infarction without diabetes recruited in 10 hospitals. We compared coronary heart disease incidence and cardiovascular mortality rates in myocardial infarction patients and diabetic patients, including subgroups by diabetes treatment, duration, and A1C. RESULTS The adjusted hazard ratios (HRs) for 10-year coronary heart disease incidence and for cardiovascular mortality were significantly lower in men and women with diabetes than in myocardial infarction patients: HR 0.54 (95% CI 0.45–0.66) and 0.28 (0.21–0.37) and 0.26 (0.19–0.36) and 0.16 (0.10–0.26), respectively. All diabetic patient subgroups had significantly fewer events than myocardial infarction patients: the HR of cardiovascular mortality ranged from 0.15 (0.09–0.26) to 0.36 (0.24–0.54) and that of coronary heart disease incidence ranged from 0.34 (0.26–0.46) to 0.56 (0.43–0.72). CONCLUSIONS Lower long-term cardiovascular risk was found in type 2 diabetic and all subgroups analyzed compared with myocardial infarction patients. These results do not support equivalence in coronary disease risk for diabetic and myocardial infarction patients.

[1]  N. Sattar,et al.  Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials , 2009, The Lancet.

[2]  R. Holman,et al.  10-year follow-up of intensive glucose control in type 2 diabetes. , 2008, The New England journal of medicine.

[3]  Z. Bloomgarden.  Glycemic Control in Diabetes: A Tale of Three Studies , 2008, Diabetes Care.

[4]  A. Vaag,et al.  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 , 2008, Circulation.

[5]  O. Pedersen,et al.  Effect of a multifactorial intervention on mortality in type 2 diabetes. , 2008, The New England journal of medicine.

[6]  Frank A Sloan,et al.  The growing burden of diabetes mellitus in the US elderly population. , 2008, Archives of internal medicine.

[7]  R. Elosua,et al.  Trends in cardiovascular risk factor prevalence (1995-2000-2005) in northeastern Spain , 2007, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[8]  J. Marrugat,et al.  [Reduction in acute myocardial infarction mortality over a five-year period]. , 2006, Revista Española de Cardiología.

[9]  F. Arós,et al.  Reducción de la mortalidad por infarto agudo de miocardio en un período de 5 años , 2006 .

[10]  Seppo Lehto,et al.  Type 2 diabetes as a "coronary heart disease equivalent": an 18-year prospective population-based study in Finnish subjects. , 2005, Diabetes care.

[11]  V. Salomaa,et al.  Myocardial infarction in diabetic and non-diabetic persons with and without prior myocardial infarction: the FINAMI Study , 2005, Diabetologia.

[12]  S. Lipsitz,et al.  Sex differences in the effect of diabetes duration on coronary heart disease mortality. , 2005, Archives of internal medicine.

[13]  F. Lobo,et al.  Direct health care costs of diabetic patients in Spain. , 2004, Diabetes care.

[14]  Lynn E Eberly,et al.  Impact of diabetes and previous myocardial infarction on long-term survival: 25-year mortality follow-up of primary screenees of the Multiple Risk Factor Intervention Trial. , 2004, Archives of internal medicine.

[15]  S. Wild,et al.  Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. , 2004, Diabetes care.

[16]  R. D'Agostino,et al.  The significant effect of diabetes duration on coronary heart disease mortality: the Framingham Heart Study. , 2004, Diabetes care.

[17]  J. Pankow,et al.  Cardiovascular Events in Diabetic and Nondiabetic Adults With or Without History of Myocardial Infarction , 2004, Circulation.

[18]  Stuart R Lipsitz,et al.  Sex differences in risk for coronary heart disease mortality associated with diabetes and established coronary heart disease. , 2003, Archives of internal medicine.

[19]  E. Rimm,et al.  The impact of diabetes mellitus and prior myocardial infarction on mortality from all causes and from coronary heart disease in men. , 2002, Journal of the American College of Cardiology.

[20]  Jixian Wang,et al.  Comparison of cardiovascular risk between patients with type 2 diabetes and those who had had a myocardial infarction: cross sectional and cohort studies , 2002, BMJ : British Medical Journal.

[21]  P. Raskin,et al.  Report of the expert committee on the diagnosis and classification of diabetes mellitus. , 1999, Diabetes care.

[22]  J. Marrugat,et al.  High prevalence of cardiovascular risk factors in Gerona, Spain, a province with low myocardial infarction incidence. REGICOR Investigators. , 1998, Journal of epidemiology and community health.

[23]  R. Holman,et al.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. , 1998 .

[24]  M. Laakso,et al.  Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. , 1998, The New England journal of medicine.

[25]  M. Fantone,et al.  Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus , 1997, Diabetes Care.

[26]  Teven,et al.  MORTALITY FROM CORONARY HEART DISEASE IN SUBJECTS WITH TYPE 2 DIABETES AND IN NONDIABETIC SUBJECTS WITH AND WITHOUT PRIOR MYOCARDIAL INFARCTION , 2000 .

[27]  Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group. , 1979, Diabetes.