CARDIOVASCULAR MEDICINE

Cardiovascular disease incidence and mortality in older men with diabetes and in men with coronary heart disease

S G Wannamethee, A G Shaper, L Lennon

Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK

Correspondence to:
Correspondence to:
Dr S G Wannamethee
Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London NW3 2PF, UK; goya{at}pcps.ucl.ac.uk

Objective: To examine the relation of diabetes and coronary heart disease (CHD; myocardial infarction (MI) or angina) to the incidence of major CHD and stroke events and total mortality.

Methods: Prospective study of 5934 men aged 52–74 years followed up for 10 years. The men were divided into five groups according to their diabetes and CHD status.

Results: During the follow up there were 662 major CHD events, 305 major stroke events, and 1357 deaths from all causes (637 cardiovascular disease (CVD) deaths, 417 CHD deaths). Men with diabetes had significantly increased cardiovascular and total mortality risk compared with non-diabetic men with no CHD but lower risk than men with prior MI only. The adjusted relative risk for CHD deaths was 2.82 (95% confidence interval (CI) 1.85 to 4.28) in men with diabetes only, 2.12 (95% CI 1.53 to 2.93) in men with angina only, 3.91 (95% CI 3.07 to 4.99) in men with MI, and 8.93 (95% CI 6.13 to 12.99) in men with both diabetes and CHD. Case fatality among men with diabetes only was similar to those with prior MI only. CHD and CVD mortality increased with increasing duration of diabetes with risk eventually approaching that of patients with MI without diabetes.

Conclusion: Men with diabetes only have a CVD risk intermediate between men with angina and men with prior MI. Their absolute risk is high and the prognosis for diabetic patients who develop CHD is extremely poor.

Abbreviations: BMI, body mass index; CHD, coronary heart disease; CI, confidence interval; CVD, cardiovascular disease; ICD-9, International classification of diseases, 9th revision; MI, myocardial infarction; OASIS, organization to assess strategies for ischemic syndromes; Q1, Q5, Q92, questionnaires administered in the first year, fifth year, and 1992

Keywords: non-insulin dependent diabetes mellitus; myocardial infarction; cardiovascular disease; mortality

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