title: Recurrence of cardiovascular events in patients with type 2 diabetes: epidemiology and risk factors.
abstract: OBJECTIVE
  The purpose of this study was to assess incidence of and risk factors for recurrent cardiovascular disease (CVD) in type 2 diabetes.
  
  
  METHODS
  We estimated the incidence of recurrent cardiovascular events in type 2 diabetic patients, aged 40-97 years, followed by a network of diabetes clinics. The analysis was conducted separately for 2,788 patients with CVD at enrollment (cohort A) and for 844 patients developing the first episode during the observation period (cohort B).
  
  
  RESULTS
  During 4 years of follow-up, in cohort A the age-adjusted incidence of a recurrent event (per 1,000 person-years) was 72.7 (95% CI 58.3-87.1) in men and 32.5 (21.2-43.7) in women, whereas in cohort B it was 40.1 (17.4-62.9) in men and 22.4 (12.9-32.0) in women. After controls were included for potential predictors (familial CVD, obesity, smoking, diabetes duration, glycemic control, microvascular complications, geographic area, and antihypertensive and lipid-lowering treatment), male sex, older age, and insulin use were significant independent risk predictors (cohort A) and serum triglyceride levels >/=1.69 mmol/l emerged as the only metabolic (negative) prognostic factor (cohort B). In both cohorts, a prior CVD episode, especially myocardial infarction, was by far the strongest predictor of recurrent CVD.
  
  
  CONCLUSIONS
  Approximately 6% of unselected diabetic patients in secondary prevention develop recurrent major CVD every year. Those with long-standing previous CVD show a higher incidence of recurrence. Male sex, age, high triglyceride levels, and insulin use are additional predictors of recurrence.
authors.affiliation: Metabolism and Diabetes Unit, Regione Piemonte, Chieri, Italy. giordaca@tin.it
authors.forename: Carlo B
authors.initials: CB
authors.lastname: Giorda
authors.forename: Angelo
authors.initials: A
authors.lastname: Avogaro
authors.forename: Marina
authors.initials: M
authors.lastname: Maggini
authors.forename: Flavia
authors.initials: F
authors.lastname: Lombardo
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
authors.forename: Salvatore
authors.initials: S
authors.lastname: Turco
authors.forename: Stefania Spila
authors.initials: SS
authors.lastname: Alegiani
authors.forename: Roberto
authors.initials: R
authors.lastname: Raschetti
authors.forename: Mario
authors.initials: M
authors.lastname: Velussi
authors.forename: Ele
authors.initials: E
authors.lastname: Ferrannini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents
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