title: Cardiovascular risk factors and diseases precede oral hypoglycaemic therapy in patients with type 2 diabetes mellitus.
abstract: Although patients with type 2 diabetes mellitus and cardiovascular disease share common risk factors, the link between these diseases remains largely unexplained. In this case-control study, the earlier use of cardiovascular drugs (before the diagnosis of diabetes) was investigated among cases with type 2 diabetes mellitus and controls without diabetes. Using the PHARMO database, we identified 4,864 patients who were prescribed oral hypoglycaemic agent (OHA) therapy between 1985-1998 in the Netherlands. For each case, two controls matched on age, sex and pharmacy were randomly selected. Controls had not received insulins or OHA therapy. There were 2,656 (55.0%) cases compared with 2,727 (28.1%) controls who used cardiovascular drugs at the start of OHA therapy. Cases had a 3.5-fold increased risk of cardiovascular drug use (OR(95% CI) = 3.5 [3.2-3.8]) compared to controls. Differences in cardiovascular drug use were noted as early as 7 years before the start of OHA therapy, distinguishing cases from controls. Our finding that patients with type 2 diabetes mellitus were more likely to receive treatment for cardiovascular disease several years before they start diabetes therapy supports the hypothesis of a common underlying mechanism of these two disorders and stresses the importance of the pre-diabetic state.
authors.affiliation: Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, Netherlands. J.A.Erkens@pharm.uu.nl
authors.forename: Joëlle A
authors.initials: JA
authors.lastname: Erkens
authors.forename: Ron M C
authors.initials: RM
authors.lastname: Herings
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Stolk
authors.forename: José A
authors.initials: JA
authors.lastname: Spoelstra
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Hubert G M
authors.initials: HG
authors.lastname: Leufkens
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000188:drug therapy* / Q000209:etiology; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents