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Mortality from Coronary Heart Disease in Subjects with Type 2 Diabetes and in Nondiabetic Subjects with and without Prior Myocardial Infarction
Open accessAbstract
BACKGROUND: Type 2 (non-insulin-dependent) diabetes is associated with a marked increase in the risk of coronary heart disease. It has been debated whether patients with diabetes who have not had myocardial infarctions should be treated as aggressively for cardiovascular risk factors as patients who have had myocardial infarctions. METHODS: To address this issue, we compared the seven-year incidence of myocardial infarction (fatal and nonfatal) among 1373 nondiabetic subjects with the incidence among 1059 diabetic subjects, all from a Finnish population-based study. RESULTS: The seven-year incidence rates of myocardial infarction in nondiabetic subjects with and without prior myocardial infarction at base line were 18.8 percent and 3.5 percent, respectively (P<0.001). The seven-year incidence rates of myocardial infarction in diabetic subjects with and without prior myocardial infarction at base line were 45.0 percent and 20.2 percent, respectively (P<0.001). The hazard ratio for death from coronary heart disease for diabetic subjects without prior myocardial infarction as compared with nondiabetic subjects with prior myocardial infarction was not significantly different from 1.0 (hazard ratio, 1.4; 95 percent confidence interval, 0.7 to 2.6) after adjustment for age and sex, suggesting similar risks of infarction in the two groups. After further adjustment for total cholesterol, hypertension, and smoking, this hazard ratio remained close to 1.0 (hazard ratio, 1.2; 95 percent confidence interval, 0.6 to 2.4). CONCLUSIONS: Our data suggest that diabetic patients without previous myocardial infarction have as high a risk of myocardial infarction as nondiabetic patients with previous myocardial infarction. These data provide a rationale for treating cardiovascular risk factors in diabetic patients as aggressively as in nondiabetic patients with prior myocardial infarction.
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“diabetes-related morbidity and mortality is primarily due to cardiovascular complications [17,18,19].”
From Recent Experimental Studies of Maternal Obesity, Diabetes during Pregnancy and the Developmental Origins of Cardiovascular Disease (2022) · cites this paper as [18]
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“Patients with type 2 diabetes mellitus have an increased incidence of atherosclerotic cardiovascular disease.1–4”
From Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus (2010) · cites this paper as [3]
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“Furthermore, T2DM is associated with low-grade inflammation,382, 383 cardiovascular disease,384, 385 nephropathy386, 387 and alterations in the secretion of various hormones, including IL-6, IL-18, tumor necrosis factor-α,388 adiponectin and leptin,389 neuropeptides,390 ghrelin391, 392 and the incretins GLP-1 and GIP.219, 220, 221, 222, 223”
From Pancreatic regulation of glucose homeostasis. (2016) · cites this paper as [384]
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“In contrast, patients who did not have T2DM, the death rates due to cardiovascular causes were 2.1 and 15.9%, respectively.”
From Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017 (2018) · cites this paper as [6]
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“Furthermore, people with T2DM are disproportionately affected by CVD compared with non-diabetic subjects [6].”
From Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017 (2018) · cites this paper as [6]
In the citing paper
“In persons with T2DM, the death rates were 15.4% for those with no prior myocardial infarction (MI) and 42.0% in patients having a history of MI.”
From Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017 (2018) · cites this paper as [6]
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“It has been stated that type 2 diabetic patients without a previous history of myocardial infarction have the same risk of coronary artery disease (CAD) as non-diabetic subjects with a history of myocardial infarction [69].”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [69]
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Metadata
- Authors
- Haffner, S. M., Lehto, S., Rönnemaa, T., Pyörälä, K., & Laakso, M.
- Affiliations
- The University of Texas at San Antonio Health Science Center (US)
- University of Eastern Finland (FI)
- University of Turku (FI)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1998-07-23
- Volume
- 339
- Issue
- 4
- Pages
- 229-234
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2331274940
- Cited by
- 7,000
- References
- 23
- Citations by year
- 2026: 59 · 2025: 82 · 2024: 103 · 2023: 145 · 2022: 152 · 2021: 190 · 2020: 217 · 2019: 255 · 2018: 195 · 2017: 262 · 2016: 232 · 2015: 295 · 2014: 289 · 2013: 337 · 2012: 367
- FWCI
- 88.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, coronary heart disease mortality, myocardial infarction incidence, cardiovascular risk factors, cardiovascular risk stratification, old myocardial infarction, total cholesterol, hypertension, smoking, diabetes and cardiovascular risk
- MeSH terms
- Coronary Disease, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Finland, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Risk Factors, Incidence, Proportional Hazards Models, Survival Analysis, Case-Control Studies
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