Type 2 diabetes as a "coronary heart disease equivalent": an 18-year prospective population-based study in Finnish subjects.
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.


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.
Juutilainen
Auni
A
University of Kuopio and Kuopio University Hospital, Department of Medicine, 70210 Kuopio, Finland.
Lehto
Seppo
S
Rönnemaa
Tapani
T
Pyörälä
Kalevi
K
Laakso
Markku
M
D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012016:Reference Values; D012727:Sex Characteristics; D016019:Survival Analysis; D013997:Time Factors