Diabetes and coronary heart disease as risk factors for mortality in older adults.
BACKGROUND
Type 2 diabetes has been described as a coronary heart disease (CHD) "risk equivalent." We tested whether cardiovascular and all-cause mortality rates were similar between participants with prevalent CHD vs diabetes in an older adult population in whom both glucose disorders and preexisting atherosclerosis are common.


METHODS
The Cardiovascular Health Study is a longitudinal study of men and women (n=5784) aged > or =65 years at baseline who were followed from baseline (1989/1992-1993) through 2005 for mortality. Diabetes was defined by fasting plasma glucose > or =7.0 mmol/L or use of diabetes control medications. Prevalent CHD was determined by confirmed history of myocardial infarction, angina, or coronary revascularization.


RESULTS
Following multivariable adjustment for other cardiovascular disease risk factors and subclinical atherosclerosis, CHD mortality risk was similar between participants with CHD alone vs diabetes alone (hazard ratio [HR] 1.04, 95% confidence interval [CI], 0.83-1.30). The proportion of mortality attributable to prevalent diabetes (population-attributable risk percent=8.4%) and prevalent CHD (6.7%) was similar in women, but the proportion of mortality attributable to CHD (16.5%) as compared with diabetes (6.4%) was markedly higher in men. Patterns were similar for cardiovascular disease mortality. By contrast, the adjusted relative hazard of total mortality was lower among participants with CHD alone (HR 0.85, 95% CI, 0.75-0.96) as compared with those who had diabetes alone.


CONCLUSIONS
Among older adults, diabetes alone confers a risk for cardiovascular mortality similar to that from established clinical CHD. The public health burden of both diabetes and CHD is substantial, particularly among women.
Carnethon
Mercedes R
MR
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. carnethon@northwestern.edu
Biggs
Mary L
ML
Barzilay
Joshua
J
Kuller
Lewis H
LH
Mozaffarian
Dariush
D
Mukamal
Kenneth
K
Smith
Nicholas L
NL
Siscovick
David
D
D000368:Aged; D003327:Coronary Disease / Q000150:complications / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D013997:Time Factors; D014481:United States / Q000453:epidemiology