Update on Type 2 Diabetes as a Cardiovascular Disease Risk Equivalent
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DIABETES AND CARDIOVASCULAR DISEASE (S MALIK, SECTION EDITOR)
Update on Type 2 Diabetes as a Cardiovascular Disease Risk Equivalent Johanna Kuusisto & Markku Laakso
Published online: 10 January 2013 # Springer Science+Business Media New York 2013
Abstract Type 2 diabetes increases the risk of cardiovascular disease (CVD) from two- to four-fold. In our large Finnish population-based study published in 1998 subjects with medication for type 2 diabetes had as high a risk of fatal and nonfatal myocardial infarction (MI) during the 7year follow-up as non-diabetic subjects with a prior MI, suggesting that type 2 diabetes is a CVD equivalent. In another large study, including all 3.3 million residents of Denmark, subjects requiring glucose-lowering therapy exhibited a CVD risk similar to that of non-diabetic subjects with a prior MI. Subsequent studies have not systematically replicated aforementioned results. Some studies have supported the concept that type 2 diabetes is a CVD equivalent only in some subgroups, and many studies have reported negative findings. This is likely to be due to many differences across the studies published, for example ethnicity, gender, age and other demographic factors of the populations involved, study design, validation of diabetes status and CVD events, statistical analyses (adjustments for confounding factors), duration of diabetes, and treatment of hyperglycemia among diabetic participants. Varying results reflect the fact that not all diabetic patients are at a similar risk for CVD. Therefore, CVD risk assessment and the tailoring of preventive measures should be done individually, taking into consideration each patient’s long-term risk of developing cardiovascular events.
This article is part of the Topical Collection on Diabetes and Cardiovascular Disease J. Kuusisto (*) : M. Laakso Department of Medicine, Centre for Medicine and Clinical Research, Kuopio University Hospital and University of Eastern Finland, P.O.B. 1777, 70211 Kuopio, Finland e-mail: [email protected]
Keywords Type 2 diabetes . Cardiovascular disease . Coronary heart disease . Risk equivalent
Introduction Diabetes increases the risk of cardiovascular disease (CVD) from two- to four-fold [1, 2]. Patients with type 2 diabetes with a history a previous myocardial infarction (MI) are at a particularly high risk of CVD. In our study, originally published in 1998, we wanted to investigate whether patients with diabetes who have not had myocardial infarction (MI) should be treated as aggressively for CVD risk factors as patients who have had MI [3]. To this aim, we compared in a Finnish population-based study the seven-year incidence of fatal and nonfatal MI among 1373 non-diabetic subjects with the incidence among 1059 type 2 diabetic subjects. Diabetic subjects were selected for our study from the Finnish nationwide drug imbursement register including patients with diabetes who were receiving glucoselowering medication (oral drug treatment or insulin). The 7-year incidence rates of MI in non-diabetic subjects
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