BMJ 2002;324:939 ( 20 April )

Papers

Comparison of cardiovascular risk between patients with type 2 diabetes and those who had had a myocardial infarction: cross sectional and cohort studies

Josie M M Evans, lecturer, a Jixian Wang, statistician, b Andrew D Morris, reader in medicine. c

a Department of Epidemiology and Public Health, Ninewells Hospital, Dundee DD1 9SY, b Department of Clinical Pharmacology, Ninewells Hospital, Dundee, c Department of Medicine, Ninewells Hospital, Dundee

Correspondence to: J M M Evans j.m.m.stansfield{at}dundee.ac.uk

Objective: To compare risks of cardiovascular outcomes between patients with type 2 diabetes and patients with established coronary heart disease.
Design: Cross sectional study and cohort study using routinely collected datasets.
Setting: Tayside, Scotland (population 400 000) during 1988-95.
Subjects: In the cross sectional study, among patients aged 45-64, 1155 with type 2 diabetes were compared with 1347 who had had a myocardial infarction in the preceding 8 years. In the cohort study 3477 patients of all ages with newly diagnosed type 2 diabetes were compared with 7414 patients who had just had a myocardial infarction.
Main outcome measures: Risk ratios for death from all causes, cardiovascular death, and hospital admission for myocardial infarction were calculated by Cox proportional hazards analysis and adjusted for age and sex.
Results: In the cross sectional study the adjusted risk ratio for death from all causes was 2.27 (95% confidence interval 1.82 to 2.83) for patients who had had myocardial infarction compared with those with diabetes, and the risk ratio for hospital admission for myocardial infarction was 1.33 (1.14 to 1.55). In the cohort study, patients who had just had a myocardial infarction had a higher risk of death from all causes (adjusted risk ratio 1.35 (1.25 to 1.44)), cardiovascular death (2.93 (2.54 to 3.41)), and hospital admission for myocardial infarction (3.10 (2.57 to 3.73)).
Conclusions: Patients with type 2 diabetes were at lower risk of cardiovascular outcomes than patients with established coronary heart disease.

What is already known on this topic
A recent influential study suggested that patients with type 2 diabetes without established cardiovascular disease have as high a risk of cardiovascular events and death as non-diabetic patients who have had a myocardial infarction

Some clinicians therefore advocate aggressive treatment of cardiovascular risk factors in the presence of diabetes

What this study adds
Patients with type 2 diabetes are at lower risk of death from all causes or cardiovascular causes and of hospital admission for myocardial infarction than patients with established coronary heart disease




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