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(Circulation. 2008;117:1945-1954.)
© 2008 American Heart Association, Inc.

Epidemiology

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

Tina Ken Schramm, MD; Gunnar H. Gislason, MD; Lars Køber, MD, DMSc; Søren Rasmussen, MSc, PhD; Jeppe N. Rasmussen, MD, PhD; Steen Z. Abildstrøm, MD, PhD; Morten Lock Hansen, MD; Fredrik Folke, MD; Pernille Buch, MD; Mette Madsen, MSc; Allan Vaag, MD, DMSc; Christian Torp-Pedersen, MD, DMSc

From the Department of Cardiology, Gentofte University Hospital, Hellerup (T.K.S., G.H.G., S.Z.A., M.L.H., F.F., P.B., C.T.-P.); National Institute of Public Health, Copenhagen (T.K.S., G.H.G., S.R., J.N.R., S.Z.A.); Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen (L.K.); Department of Public Health, University of Copenhagen, Copenhagen (M.M.); and Steno Diabetes Center, Gentofte (A.V.), Denmark.

Correspondence to Dr Tina Ken Schramm, MD, Research Fellow, Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, DK-2900, Hellerup, Denmark. E-mail tks{at}heart.dk

Received June 12, 2007; accepted January 22, 2008.

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.

Methods and Results— All residents in Denmark 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 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.

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