A 10-year follow-up of the PROCAM study
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Previous studies suggest that diabetes mellitus without previous CHD carries a lifetime risk of vascular death as high as that for CHD alone in both men and women. According to the American and European consensus opinions, diabetes mellitus is regarded as conferring the same risk of myocardial infarction as established coronary disease. To examine whether this is true for men in the Prospective Cardiovascular Munster Study (PROCAM), a single-centre, prospective, epidemiological study was conducted in men working for public administrations or large companies in Munster (Germany) by using the PROCAM risk calculator, which takes diabetes mellitus into account. Among the 5389 men recruited (aged 35-65 years), glycaemic status and coronary events were followed-up for 10 years. In total, 13.3% of men with diabetes mellitus suffered a coronary event within 10 years compared with 7.3% of men with impaired fasting glucose and 5.3% of normoglycaemic men. Using the PROCAM risk calculator, only 26.5% of the men with diabetes mellitus were classified as being at high risk (10-year coronary event risk =20%, which is regarded as equivalent to the risk conferred by established coronary heart disease), compared with 8% of men with impaired fasting glucose and 5.5% of normoglycaemic men. The positive predictive value of high-risk estimate was 35%, 32% and 31% for diabetes mellitus, impaired glucose tolerance and normoglycaemia, respectively. According to the authors, it is incorrect to regard the presence of diabetes mellitus as a coronary risk equivalent in a overall male population with moderate cardiovascular risk.
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