Cardiovascular Disease In Diabetes

Heart disease and stroke account for more than two thirds of all deaths among diabetic patients.2 A recent population-based study documented that diabetes confers a CV risk equivalent to aging 15 years.25 In 2001, the Adult Treatment Panel III of the National Cholesterol Education Program (NCEP ATP III) recommended that diabetes be considered a CAD risk equivalent, thus mandating aggressive CV risk pre-vention.26 The notion of diabetes as a CAD risk equivalent came initially from a Finnish population-based study with 7-year follow-up involving 1059 diabetic patients and 1373 nondiabetic patients, which showed that diabetic patients without known CAD had the same likelihood of experiencing an MI as nondiabetic counterparts with a previous history of MI.27 A similar observation was made in a registry enrolling more than 8000 patients with ACS, which showed that diabetic patients with no previous CVD had the same long-term morbidity and mortality as nondiabetic patients with established CVD before hospital admission.28 Finally, additional data were provided by the 18-year follow-up of the mentioned Finnish study.29 Adjusted multivariate Cox hazard models indicated that diabetic subjects without prior MI had mortality rates similar to those of nondia-betic subjects with prior MI (Fig. 2-3). In addition, diabetic subjects without prior evidence of CVD (i.e., MI, angina, or ischemic ECG changes) had a significantly higher risk of death than nondiabetic subjects with prior evidence of CVD (hazard ratio [HR] = 1.5 for men and 3.5 for women).29

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