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Diabetes Is Not Treated as a Coronary Artery Disease Risk Equivalent

From the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

Address correspondence and reprint requests to Baiju R. Shah, MD, the Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, Ontario M4N3M5, Canada. E-mail: baiju.shah@ices.on.ca

Abbreviations: MI, myocardial infarction

The first 20% of the full text of this article appears below.

	INTRODUCTION

 
Observational studies (1–3) have suggested that the risk of mortality is equivalent for patients with myocardial infarction (MI) without previous diabetes and for diabetic patients without previous MI. Because vascular risk-reduction targets are based on a patient’s future risk, clinical practice guidelines (4–9) recommend that the same or lower blood pressure and lipid targets be applied to diabetic patients as would be applied for secondary prevention following MI. Patients newly diagnosed with diabetes and those with first MIs enter a high-risk category for subsequent coronary events. Therefore, if diabetes were treated as a coronary artery disease risk equivalent, we would expect that both groups of patients should have similar increases in utilization of antihypertensive and lipid-lowering medications following their index events.

	RESEARCH DESIGN AND METHODS—

 
The study used administrative health databases from Ontario, Canada, including hospital discharge abstracts, physician service claims, and records from the government drug insurance program, which covers all prescriptions filled for individuals aged 65 years. Individuals are linked between databases via an anonymous identification number. The study also used the Ontario Diabetes Database, a validated registry of all individuals with diabetes, derived from these administrative databases (10).

All individuals with no history of MI or diabetes were identified, and two cohorts . . . [Full Text of this Article]

	RESULTS—

 

	CONCLUSIONS—

 

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