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Previous Volume 339:229-234 July 23, 1998 Number 4 Next

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ABSTRACT

Background Type 2 (non-insulin-dependent) diabetes is associated with a marked increase in the risk of coronary heart disease. It has been debated whether patients with diabetes who have not had myocardial infarctions should be treated as aggressively for cardiovascular risk factors as patients who have had myocardial infarctions.

Methods To address this issue, we compared the seven-year incidence of myocardial infarction (fatal and nonfatal) among 1373 nondiabetic subjects with the incidence among 1059 diabetic subjects, all from a Finnish population-based study.

Results The seven-year incidence rates of myocardial infarction in nondiabetic subjects with and without prior myocardial infarction at base line were 18.8 percent and 3.5 percent, respectively (P<0.001). The seven-year incidence rates of myocardial infarction in diabetic subjects with and without prior myocardial infarction at base line were 45.0 percent and 20.2 percent, respectively (P<0.001). The hazard ratio for death from coronary heart disease for diabetic subjects without prior myocardial infarction as compared with nondiabetic subjects with prior myocardial infarction was not significantly different from 1.0 (hazard ratio, 1.4; 95 percent confidence interval, 0.7 to 2.6) after adjustment for age and sex, suggesting similar risks of infarction in the two groups. After further adjustment for total cholesterol, hypertension, and smoking, this hazard ratio remained close to 1.0 (hazard ratio, 1.2; 95 percent confidence interval, 0.6 to 2.4).

Conclusions Our data suggest that diabetic patients without previous myocardial infarction have as high a risk of myocardial infarction as nondiabetic patients with previous myocardial infarction. These data provide a rationale for treating cardiovascular risk factors in diabetic patients as aggressively as in nondiabetic patients with prior myocardial infarction.

Source Information

From the Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio (S.M.H.); the Department of Medicine, University of Kuopio, Kuopio, Finland (S.L., K.P., M.L.); and the Department of Medicine, Turku University, Turku, Finland (T.R.).

Address reprint requests to Dr. Haffner at the Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78284-7873.

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Extract | Full Text  
N Engl J Med 1998; 339:1714-1716, Dec 3, 1998. Correspondence

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• Steinhubl, S. R., Badimon, J. J., Bhatt, D. L., Herbert, J.-M., Luscher, T. F. (2007). Clinical evidence for anti-inflammatory effects of antiplatelet therapy in patients with atherothrombotic disease. Vasc Med 12: 113-122 [Abstract]  
• Gowdak, L. H. W., de Paula, F. J., Cesar, L. A. M., Filho, E. E. M., Ianhez, L. E., Krieger, E. M., Ramires, J. A. F., De Lima, J. J. G. (2007). Diabetes and coronary artery disease impose similar cardiovascular morbidity and mortality on renal transplant candidates. Nephrol Dial Transplant 22: 1456-1461 [Abstract] [Full Text]  
• Westerbacka, J. (2007). PROactive in Patients With Type 2 Diabetes and Previous Myocardial Infarction: Swinging the Sword of Damocles?. J Am Coll Cardiol 49: 1781-1782 [Full Text]  
• Erdmann, E., Dormandy, J. A., Charbonnel, B., Massi-Benedetti, M., Moules, I. K., Skene, A. M., on behalf of the PROactive Investigators, (2007). The Effect of Pioglitazone on Recurrent Myocardial Infarction in 2,445 Patients With Type 2 Diabetes and Previous Myocardial Infarction: Results From the PROactive (PROactive 05) Study. J Am Coll Cardiol 49: 1772-1780 [Abstract] [Full Text]  
• Pundziute, G., Schuijf, J. D., Jukema, J. W., Boersma, E., Scholte, A. J.H.A., Kroft, L. J.M., van der Wall, E. E., Bax, J. J. (2007). Noninvasive Assessment of Plaque Characteristics With Multislice Computed Tomography Coronary Angiography in Symptomatic Diabetic Patients. Diabetes Care 30: 1113-1119 [Abstract] [Full Text]  
• Avogaro, A., Giorda, C., Maggini, M., Mannucci, E., Raschetti, R., Lombardo, F., Spila-Alegiani, S., Turco, S., Velussi, M., Ferrannini, E., for the Diabetes and Informatics Study Group, Asso, (2007). Incidence of Coronary Heart Disease in Type 2 Diabetic Men and Women: Impact of microvascular complications, treatment, and geographic location. Diabetes Care 30: 1241-1247 [Abstract] [Full Text]  
• Corsetti, J. P., Ryan, D., Moss, A. J., Rainwater, D. L., Zareba, W., Sparks, C. E. (2007). Glycoprotein Ib{alpha} Polymorphism T145M, Elevated Lipoprotein-Associated Phospholipase A2, and Hypertriglyceridemia Predict Risk for Recurrent Coronary Events in Diabetic Postinfarction Patients. Diabetes 56: 1429-1435 [Abstract] [Full Text]  
• Hafstad, A. D., Khalid, A. M., How, O.-J., Larsen, T. S., Aasum, E. (2007). Glucose and insulin improve cardiac efficiency and postischemic functional recovery in perfused hearts from type 2 diabetic (db/db) mice. Am. J. Physiol. Endocrinol. Metab. 292: E1288-E1294 [Abstract] [Full Text]  
• Kakafika, A. I., Mikhailidis, D. P., Karagiannis, A., Athyros, V. G. (2007). The Role of Endocannabinoid System Blockade in the Treatment of the Metabolic Syndrome. J Clin Pharmacol 47: 642-652 [Abstract] [Full Text]