Type 2 Diabetes as a “Coronary Heart Disease Equivalent”

Abstract

OBJECTIVE -The purpose of this study was to investigate the hypothesis that coronary heart disease (CHD) mortality in diabetic subjects without prior evidence of CHD is equal to that in nondiabetic subjects with prior myocardial infarction or any prior evidence of CHD.RESEARCH DESIGN AND METHODS -During an 18-year follow-up total, cardiovascular disease (CVD) and CHD deaths were registered in a Finnish population-based study of 1,373 nondiabetic and 1,059 diabetic subjects.RESULTS -Adjusted multivariate Cox hazard models indicated that diabetic subjects without prior myocardial infarction, compared with nondiabetic subjects with prior myocardial infarction, had a hazard ratio (HR) of 0.9 (95% CI 0.6 -1.5) for the risk of CHD death. The corresponding HR was 0.9 (0.5-1.4) in men and 1.9 (0.6 -6.1) in women. Diabetic subjects without any prior evidence of CHD (myocardial infarction or ischemic electrocardiogram [ECG] changes or angina pectoris), compared with nondiabetic subjects with prior evidence of CHD, had an HR of 1.9 (1.4 -2.6) for CHD death (men 1.5 [1.0 -2.2]; women 3.5 [1.8 -6.8]). The results for CVD and total mortality were quite similar to those for CHD mortality.CONCLUSIONS -Diabetes without prior myocardial infarction and prior myocardial infarction without diabetes indicate similar risk for CHD death in men and women. However, diabetes without any prior evidence of CHD (myocardial infarction or angina pectoris or ischemic ECG changes) indicates a higher risk than prior evidence of CHD in nondiabetic subjects, especially in women. Diabetes Care 28:2901-2907, 2005T ype 2 diabetes increases the risk of coronary heart disease (CHD) events at least by two-to threefold in type 2 diabetic subjects compared with nondiabetic subjects (1). In type 2 diabetic women the relative risk is even greater (2). The reasons for this increased risk are largely unknown but could be related at least in part to more adverse changes in cardiovascular risk factors among diabetic women compared with diabetic men. Although the incidence of CHD events in nondiabetic subjects has considerably decreased during the last decades, this is not true for type 2 diabetic patients, particularly for women (3).We previously reported that type 2 diabetic patients without a history of prior myocardial infarction have the same risk of CHD death as nondiabetic subjects with a history of prior myocardial infarction (4). This observation has led to the conclusion that type 2 diabetes is a CHD equivalent and has had a profound effect, particularly on the recommendations for treatment of dyslipidemia (5).During recent years other studies have investigated the same question in different populations and study settings. Contradictory results have been obtained, with some studies confirming our original findings (6 -10) and some studies reporting opposite results, especially among men (11-18). The conclusion of these studies is that type 2 diabetes might be a CHD equivalent, but only among women.Our original study population included 1,059 patients ...

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