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; Gunnar H Gislason; Lars Køber; Søren Rasmussen; Jeppe Nørgaard Rasmussen; Steen Zabell Abildstrøm; Morten Lock Hansen; Fredrik Folke; Pernille Buch; Mette Madsen; Allan Vaag; Christian Torp-Pedersen

doi:10.1161/CIRCULATIONAHA.107.720847

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, Gunnar H Gislason, Lars Køber, Søren Rasmussen, Jeppe Nørgaard Rasmussen, Steen Zabell Abildstrøm, Morten Lock Hansen, Fredrik Folke, Pernille Buch, Mette Madsen, Allan Vaag, Christian Torp-Pedersen

Department of Public Health

392 Citations (Scopus)

Abstract

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 > or = 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 > or = 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.

Original language	English
Journal	Circulation
Volume	117
Issue number	15
Pages (from-to)	1945-54
Number of pages	9
ISSN	0009-7322
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.107.720847
Publication status	Published - 2008

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10.1161/CIRCULATIONAHA.107.720847

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Schramm, T. K., Gislason, G. H., Køber, L., Rasmussen, S., Rasmussen, J. N., Abildstrøm, S. Z., Hansen, M. L., Folke, F., Buch, P., Madsen, M., Vaag, A., & Torp-Pedersen, C. (2008). 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. Circulation, 117(15), 1945-54. https://doi.org/10.1161/CIRCULATIONAHA.107.720847

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. / Schramm, Tina Ken; Gislason, Gunnar H; Køber, Lars et al.

In: Circulation, Vol. 117, No. 15, 2008, p. 1945-54.

Research output: Contribution to journal › Journal article › Research › peer-review

Schramm, TK, Gislason, GH, Køber, L, Rasmussen, S, Rasmussen, JN, Abildstrøm, SZ, Hansen, ML, Folke, F, Buch, P, Madsen, M, Vaag, A & Torp-Pedersen, C 2008, '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.', Circulation, vol. 117, no. 15, pp. 1945-54. https://doi.org/10.1161/CIRCULATIONAHA.107.720847

@article{78c8dad021d611ddbc23000ea68e967b,

title = "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.",

abstract = "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 > or = 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 > or = 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.",

author = "Schramm, {Tina Ken} and Gislason, {Gunnar H} and Lars K{\o}ber and S{\o}ren Rasmussen and Rasmussen, {Jeppe N{\o}rgaard} and Abildstr{\o}m, {Steen Zabell} and Hansen, {Morten Lock} and Fredrik Folke and Pernille Buch and Mette Madsen and Allan Vaag and Christian Torp-Pedersen",

note = "Keywords: Adult; Age Factors; Aged; Aged, 80 and over; Cardiovascular Agents; Cardiovascular Diseases; Comorbidity; Denmark; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Forecasting; Humans; Hypoglycemic Agents; Insulin; Male; Middle Aged; Myocardial Infarction; Proportional Hazards Models; Recurrence; Registries; Risk; Stroke; Survival Analysis",

year = "2008",

doi = "10.1161/CIRCULATIONAHA.107.720847",

language = "English",

volume = "117",

pages = "1945--54",

journal = "Circulation",

issn = "0009-7322",

publisher = "AHA/ASA",

number = "15",

}

TY - JOUR

T1 - 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.

AU - Schramm, Tina Ken

AU - Gislason, Gunnar H

AU - Køber, Lars

AU - Rasmussen, Søren

AU - Rasmussen, Jeppe Nørgaard

AU - Abildstrøm, Steen Zabell

AU - Hansen, Morten Lock

AU - Folke, Fredrik

AU - Buch, Pernille

AU - Madsen, Mette

AU - Vaag, Allan

AU - Torp-Pedersen, Christian

N1 - Keywords: Adult; Age Factors; Aged; Aged, 80 and over; Cardiovascular Agents; Cardiovascular Diseases; Comorbidity; Denmark; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Forecasting; Humans; Hypoglycemic Agents; Insulin; Male; Middle Aged; Myocardial Infarction; Proportional Hazards Models; Recurrence; Registries; Risk; Stroke; Survival Analysis

PY - 2008

Y1 - 2008

N2 - 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 > or = 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 > or = 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.

AB - 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 > or = 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 > or = 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.

U2 - 10.1161/CIRCULATIONAHA.107.720847

DO - 10.1161/CIRCULATIONAHA.107.720847

M3 - Journal article

C2 - 18378618

SN - 0009-7322

VL - 117

SP - 1945

EP - 1954

JO - Circulation

JF - Circulation

IS - 15

ER -

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.

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