title: 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.
abstract: BACKGROUND
  Previous studies reveal major differences in the estimated cardiovascular risk in diabetes mellitus, including uncertainty about the risk in young patients. Therefore, large studies of well-defined populations are needed.
  
  
  RESULTS
  All residents in Denmark > or = 30 years of age were followed up for 5 years (1997 to 2002) by individual-level linkage of nationwide registers. Diabetes patients receiving glucose-lowering medications and nondiabetics with and without a prior myocardial infarction were compared. At baseline, 71 801 (2.2%) had diabetes mellitus and 79 575 (2.4%) had a prior myocardial infarction. Regardless of age, age-adjusted Cox proportional-hazard ratios for cardiovascular death were 2.42 (95% confidence interval [CI], 2.35 to 2.49) in men with diabetes mellitus without a prior myocardial infarction and 2.44 (95% CI, 2.39 to 2.49) in nondiabetic men with a prior myocardial infarction (P=0.60), with nondiabetics without a prior myocardial infarction as the reference. Results for women were 2.45 (95% CI, 2.38 to 2.51) and 2.62 (95% CI, 2.55 to 2.69) (P=0.001), respectively. For the composite of myocardial infarction, stroke, and cardiovascular death, the hazard ratios in men with diabetes only were 2.32 (95% CI, 2.27 to 2.38) and 2.48 (95% CI, 2.43 to 2.54) in those with a prior myocardial infarction only (P=0.001). Results for women were 2.48 (95% CI, 2.43 to 2.54) and 2.71 (95% CI, 2.65 to 2.78) (P=0.001), respectively. Risks were similar for both diabetes types. Analyses with adjustments for comorbidity, socioeconomic status, and prophylactic medical treatment showed similar results, and propensity score-based matched-pair analyses supported these findings.
  
  
  CONCLUSIONS
  Patients requiring glucose-lowering therapy who were > or = 30 years of age exhibited a cardiovascular risk comparable to nondiabetics with a prior myocardial infarction, regardless of sex and diabetes type. Therefore, requirement for glucose-lowering therapy should prompt intensive prophylactic treatment for cardiovascular diseases.
authors: Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, DK-2900, Hellerup, Denmark. tks@heart.dk
authors: Tina Ken
authors: TK
authors: Schramm
authors: Gunnar H
authors: GH
authors: Gislason
authors: Lars
authors: L
authors: Køber
authors: Søren
authors: S
authors: Rasmussen
authors: Jeppe N
authors: JN
authors: Rasmussen
authors: Steen Z
authors: SZ
authors: Abildstrøm
authors: Morten Lock
authors: ML
authors: Hansen
authors: Fredrik
authors: F
authors: Folke
authors: Pernille
authors: P
authors: Buch
authors: Mette
authors: M
authors: Madsen
authors: Allan
authors: A
authors: Vaag
authors: Christian
authors: C
authors: Torp-Pedersen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005544:Forecasting; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D012306:Risk; D020521:Stroke / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis
chemical_list: D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents; D007328:Insulin