Long-Term Cardiovascular Risk in Type 2 Diabetic Compared With Nondiabetic First Acute Myocardial Infarction Patients: A population-based cohort study in southern Europe

J. Francisco Cano; Jose M. Baena-Diez; Josep Franch; Joan Vila; Susana Tello; Joan Sala; Roberto Elosua; Jaume Marrugat; on behalf of the REGICOR and GEDAPS Investigators

doi:10.2337/dc10-0560

Original Research

Long-Term Cardiovascular Risk in Type 2 Diabetic Compared With Nondiabetic First Acute Myocardial Infarction Patients

A population-based cohort study in southern Europe

J. Francisco Cano, MD¹,
Jose M. Baena-Diez, MD²,³,
Josep Franch, MD, PHD⁴,
Joan Vila, MSC²,⁵,
Susana Tello, MSC²,
Joan Sala, MD, PHD⁶,
Roberto Elosua, MD, PHD²,⁵,
Jaume Marrugat, MD, PHD² and
on behalf of the REGICOR and GEDAPS Investigators*

¹Endocrinology and Nutrition Department, Hospital Universitari del Mar, Barcelona, Spain;
²Cardiovascular Epidemiology and Genetics Research Group, Program of Research on Inflammatory and Cardiovascular Disorders, IMIM, Barcelona, Spain;
³Primary Health Care Center La Marina, Fundació Jordi Gol i Gurina, Institut Català de la Salut, Barcelona, Spain;
⁴Primary Health Care Center Raval Sud, Institut Català de la Salut, Barcelona, Spain;
⁵Centro de Investigación Biomédica en Red Epidemiology and Public Health, Barcelona, Spain;
⁶Cardiology Department, Hospital Universitari Josep Trueta, Institut Català de la Salut, Girona, Spain.

Corresponding author: Jaume Marrugat, jmarrugat{at}imim.es.

Diabetes Care 2010 Sep; 33(9): 2004-2009. https://doi.org/10.2337/dc10-0560

Abstract

OBJECTIVE The aim of this study was to determine whether long-term cardiovascular risk differs in type 2 diabetic patients compared with first acute myocardial infarction patients in a Mediterranean region, considering therapy, diabetes duration, and glycemic control.

RESEARCH DESIGN AND METHODS A prospective population-based cohort study with 10-year follow-up was performed in 4,410 patients aged 30–74 years: 2,260 with type 2 diabetes without coronary heart disease recruited in 53 primary health care centers and 2,150 with first acute myocardial infarction without diabetes recruited in 10 hospitals. We compared coronary heart disease incidence and cardiovascular mortality rates in myocardial infarction patients and diabetic patients, including subgroups by diabetes treatment, duration, and A1C.

RESULTS The adjusted hazard ratios (HRs) for 10-year coronary heart disease incidence and for cardiovascular mortality were significantly lower in men and women with diabetes than in myocardial infarction patients: HR 0.54 (95% CI 0.45–0.66) and 0.28 (0.21–0.37) and 0.26 (0.19–0.36) and 0.16 (0.10–0.26), respectively. All diabetic patient subgroups had significantly fewer events than myocardial infarction patients: the HR of cardiovascular mortality ranged from 0.15 (0.09–0.26) to 0.36 (0.24–0.54) and that of coronary heart disease incidence ranged from 0.34 (0.26–0.46) to 0.56 (0.43–0.72).

CONCLUSIONS Lower long-term cardiovascular risk was found in type 2 diabetic and all subgroups analyzed compared with myocardial infarction patients. These results do not support equivalence in coronary disease risk for diabetic and myocardial infarction patients.

Footnotes

↵*A complete list of the researchers participating in REGICOR (Registre Gironí del Cor [Girona Heart Registry]) and GEDAPS (Grup de Estudi de la Diabetes en Atenció Primària de Salut [Primary Health Care Diabetes Study Group]) can be found at http://www.regicor.org/regicor_inv and http://www.regicor.org/gedaps_inv, respectively.
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Received March 24, 2010.
Accepted May 31, 2010.

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