title: Impact of incident diabetes and incident nonfatal cardiovascular disease on 18-year mortality: the multiple risk factor intervention trial experience.
abstract: OBJECTIVE
  To report long-term risks for total, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality associated with incident diabetes (using current diagnostic criteria) and with incident nonfatal CVD (NF-CVD).
  
  
  METHODS
  A total of 11645 participants without diabetes or CVD at baseline from the Multiple Risk Factor Intervention Trial who survived to the end of the trial were grouped by during-trial incident diabetes and/or NF-CVD events: neither diabetes nor NF-CVD, diabetes only, NF-CVD only, or both diabetes and NF-CVD. Incident diabetes was defined by use of hypoglycemic agents or fasting glucose >or=126 mg/dl at any time over the 6 trial years. Proportional hazards models tested group differences in mortality over 18 post-trial years.
  
  
  RESULTS
  Among 3859 total deaths were 1846 from CVD and 1277 from CHD, with death rates per 10000 person-years of 203, 97, and 67, respectively. Multivariate-adjusted hazard ratios (HRs) for total mortality were 2.75 (P < 0.0001) for those with NF-CVD and diabetes both, 1.92 (P < 0.0001) for those with NF-CVD only, and 1.49 (P < 0.0001) for those with diabetes only, relative to neither diabetes nor NF-CVD. NF-CVD was associated with a higher hazard of death than diabetes for total (HR 1.29, P = 0.0004), CVD (HR 1.76, P < 0.0001), and CHD (HR 1.88, P < 0.0001) mortality. Only the subgroup of participants on hypoglycemic agents showed an equivalent risk of total mortality relative to participants with NF-CVD (HR 0.93, P = 0.54).
  
  
  CONCLUSIONS
  Current diabetes diagnostic criteria conferred significantly increased total, CVD, and CHD mortality risks independent of the impact of NF-CVD. NF-CVD was more strongly predictive of mortality.
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455-0378, USA. lynn@biostat.umn.edu
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Eberly
authors.forename: Jerome D
authors.initials: JD
authors.lastname: Cohen
authors.forename: Ronald
authors.initials: R
authors.lastname: Prineas
authors.forename: Lingfeng
authors.initials: L
authors.lastname: Yang
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000401:mortality*; D003920:Diabetes Mellitus / Q000401:mortality*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011897:Random Allocation; D012307:Risk Factors; D016019:Survival Analysis