Diabetes, Other Risk Factors, and 12-Yr Cardiovascular Mortality for Men Screened in the Multiple Risk Factor Intervention Trial
- Jeremiah Stamler, MD,
- Olga Vaccaro, MD,
- James D Neaton, PHD,
- Deborah Wentworth, MPH and
- The Multiple Risk Factor Intervention Trial Research Group
- Department of Preventive Medicine, Northwestern University Medical School Chicago, Illinois Department of Internal Medicine and Metabolic Diseases, Second Faculty of Medicine, University of Naples Naples, Italy Division Of Biostatistics, School of Public Health, University of Minnesota Minneapolis, Minnesota National Heart, Lung, and Blood Institute Bethesda, Maryland
- Address correspondence and reprint requests to Jeremiah Stamler, md, Northwestern University Medical School, Department Of Preventive Medicine, 680 North Lake Shore Drive, Suite 1102, Chicago, IL 60611-4402.
OBJECTIVE To assess predictors of CVD mortality among men with and without diabetes and to assess the independent effect of diabetes on the risk of CVD death.
RESEARCH DESIGN AND METHODS Participants in this cohort study were screened from 1973 to 1975; vital status has been ascertained over an average of 12 yr of follow-up (range 11–13 yr). Participants were 347,978 men aged 35–57 yr, screened in 20 centers for MRFIT. The outcome measure was CVD mortality.
RESULTS Among 5163 men who reported taking medication for diabetes, 1092 deaths (603 CVD deaths) occurred in an average of 12 yr of follow-up. Among 342,815 men not taking medication for diabetes, 20,867 deaths were identified, 8965 ascribed to CVD. Absolute risk of CVD death was much higher for diabetic than nondiabetic men of every age stratum, ethnic background, and risk factor level—overall three times higher, with adjustment for age, race, income, serum cholesterol level, sBP, and reported number of cigarettes/day (P < 0.0001). For men both with and without diabetes, serum cholesterol level, sBP, and cigarette smoking were significant predictors of CVD mortality. For diabetic men with higher values for each risk factor and their combinations, absolute risk of CVD death increased more steeply than for nondiabetic men, so that absolute excess risk for diabetic men was progressively greater than for nondiabetic men with higher risk factor levels.
CONCLUSIONS These findings emphasize the importance of rigorous sustained intervention in people with diabetes to control blood pressure, lower serum cholesterol, and abolish cigarette smoking, and the importance of considering nutritional-hygienic approaches on a mass scale to prevent diabetes.
- Received March 11, 1992.
- Revision received March 6, 1992.
- Accepted March 6, 1992.
- Copyright © 1993 by the American Diabetes Association