title: Low incidence of cardiovascular events in Japanese patients with Type 2 diabetes in primary care settings: a prospective cohort study (JDDM 20).
abstract: OBJECTIVE
  To investigate whether a reduced incidence of cardiovascular disease in Type 2 diabetes can be achieved in a newly recruited cohort following the recently advanced concept of multifactorial treatment and followed in primary care settings as compared with earlier cohorts.
  
  
  METHODS
  A prospective study was performed in primary care settings at multiple clinics nationwide in the Japan Diabetes Clinical Data Management (JDDM) study group. Subjects were 2984 patients with Type 2 diabetes without prevalent cardiovascular disease. The main outcome measure was the first event of non-fatal or fatal coronary heart disease, ischaemic stroke or peripheral artery disease, and the incidence was compared with other representative cohorts.
  
  
  RESULTS
  There were 90 cardiovascular events over 10,827 person-years of follow-up with a dropout rate of 6%. The incidences (per 1000 person-years, 95% confidence interval) of composite, coronary heart disease, ischaemic stroke and peripheral artery disease in the JDDM study were 8.3 (6.6-10.0), 4.4 (3.2-5.6), 3.1 (2.1-4.2), and 0.7 (0.2-1.2), respectively. Each incidence was lowest in the JDDM study compared with other cohorts (P < 0.01 vs. each cohort). In the JDDM study, significant variables predictive of the occurrence of a cardiovascular event were age, duration of diabetes, HbA(1c), HDL cholesterol and urinary albumin.
  
  
  CONCLUSIONS
  The novel finding of low cardiovascular disease occurrence in this study may be conferred by the feasibility at primary care settings for providing patients with Type 2 diabetes with favourable control of blood glucose, blood pressure and lipids, coupled with unique ethnicity/country factors.
authors.affiliation: Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan. hiroki@m2,octv.ne.jp
authors.forename: H
authors.initials: H
authors.lastname: Yokoyama
authors.forename: M
authors.initials: M
authors.lastname: Matsushima
authors.forename: K
authors.initials: K
authors.lastname: Kawai
authors.forename: K
authors.initials: K
authors.lastname: Hirao
authors.forename: M
authors.initials: M
authors.lastname: Oishi
authors.forename: H
authors.initials: H
authors.lastname: Sugimoto
authors.forename: H
authors.initials: H
authors.lastname: Takeda
authors.forename: M
authors.initials: M
authors.lastname: Minami
authors.forename: M
authors.initials: M
authors.lastname: Kobayashi
authors.forename: H
authors.initials: H
authors.lastname: Sone
mesh_terms: D044466:Asian People / Q000706:statistics & numerical data*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011446:Prospective Studies; D020521:Stroke / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin