Requirement for glucose-lowering therapy should prompt intensive prophylactic treatment for cardiovascular diseases
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The study aimed to better estimate cardiovascular risk in well-defined populations with diabetes mellitus. To this end, all Danish residents aged ≥30 years were followed up from 1997 to 2002 by individual-level linkage of nationwide registers. Diabetic patients requiring glucose-lowering medications and nondiabetics with and without a prior myocardial infarction were compared. Age-adjusted Cox proportional-hazard ratios for cardiovascular death were 2.42 in men with diabetes mellitus without prior myocardial infarction and 2.44 in nondiabetic men with a prior myocardial infarction, nondiabetics without a prior myocardial infarction being the reference. Results for women were 2.45 and 2.62, respectively. For the composite of myocardial infarction, stroke, and cardiovascular death, the hazard ratios were 2.32 in men with diabetes only and 2.48 in those with a prior myocardial infarction only. For women, results were 2.48 and 2.71, respectively. Cardiovascular risks were comparable for both types of diabetes. After adjusting for comorbidity, socioeconomic factors and prophylactic medical treatment, similar results were obtained. In conclusion, in a whole population-based study of 3.3 million people, patients receiving glucose-lowering therapy aged ≥30 years showed a cardiovascular risk comparable to nondiabetic patients with a prior myocardial infarction, independently of sex and diabetes type. According to the authors, requirement for glucose-lowering therapy should prompt intensive prophylactic treatment for cardiovascular diseases in diabetic patients, regardless of other risk factors, gender, or type of diabetes mellitus.
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