Cardiovascular events in type 2 diabetes: comparison with nondiabetic individuals without and with prior cardiovascular disease: 10-year follow-up of the Hoorn Study

• Published in: European heart journal 2003-08, Vol.24 (15), p.1406-1413
• Main Authors: BECKER, Annemarie, BOS, Griët, DE VEGT, Femmie, KOSTENSE, Piet J, DEKKER, Jacqueline M, NIJPELS, Giel, HEINE, Robert J, BOUTER, Lex M, STEHOUWER, Coen D. A
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Diabetes Mellitus, Type 2 - complications; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - etiology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiologic Factors; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Male; Medical sciences; Middle Aged
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1016/S0195-668X(03)00197-0

We questioned whether prior cardiovascular disease has the same impact on risk of cardiovascular events as type 2 diabetes, and whether this differed between men and women. To address these issues we compared the 10-year risk of cardiovascular events among 208 Caucasian individuals with diabetes to that of 2253 Caucasian individuals without diabetes, in a population-based cohort study. Gender significantly modified the association between type 2 diabetes and cardiovascular events (p=0.01). The hazard ratio of cardiovascular events associated with the presence of diabetes was higher in women (adjusted hazard ratio, 1.8; 95% CI, 1.2 to 2.7) than in men (adjusted hazard ratio, 1.3; 0.9 to 2). As compared to men without diabetes but with prior cardiovascular disease, risk of cardiovascular events was significantly lower in men with diabetes but without prior cardiovascular disease (adjusted hazard ratio, 0.5; 0.3 to 0.9). In contrast, this risk was equal in women with diabetes but without prior cardiovascular disease and women without diabetes but with prior cardiovascular disease (adjusted hazard ratio, 1.0; 0.6 to 1.7; P for interaction between gender and diabetes=0.05). Women with diabetes but without prior cardiovascular disease have a risk of cardiovascular events that is similar to that of women without diabetes but with prior cardiovascular disease, whereas in men the presence of prior cardiovascular disease conferred a higher risk. These data emphasise the necessity of aggressive treatment of cardiovascular risk factors in women with type 2 diabetes.