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A Population-Based Study of 13 000 Men and Women With 20 Years of Follow-up

Thomas Almdal, DMSc; Henrik Scharling, MS; Jan Skov Jensen, DMSc; Henrik Vestergaard, DMSc

Arch Intern Med. 2004;164:1422-1426.

Background  Epidemiological studies have reported that patients with type 2 diabetes mellitus (DM) have increased mortality and morbidity from cardiovascular diseases, independent of other risk factors. However, most of these studies have been performed in selected patient groups. The purpose of the present study was prospectively to assess the impact of type 2 DM on cardiovascular morbidity and mortality in an unselected population.

Methods  A total of 13 105 subjects from the Copenhagen City Heart Study were followed up prospectively for 20 years. Adjusted relative risks of first, incident, admission for, or death from ischemic heart disease, acute myocardial infarction, or stroke, as well as total mortality in persons with type 2 DM compared with healthy controls, were estimated.

Results  The relative risk of first, incident, and admission for myocardial infarction was increased 1.5- to 4.5-fold in women and 1.5- to 2-fold in men, with a significant difference between sexes. The relative risk of first, incident, and admission for stroke was increased 2- to 6.5-fold in women and 1.5- to 2-fold in men, with a significant difference between sexes. In both women and men the relative risk of death was increased 1.5 to 2 times.

Conclusions  In persons with type 2 DM, the risk of having an incident myocardial infarction or stroke is increased 2- to 3-fold and the risk of death is increased 2-fold, independent of other known risk factors for cardiovascular diseases.

From the Department of Endocrinology, Copenhagen University Hospital Hvidovre (Dr Almdal), Department of Endocrinology, Copenhagen University Hospital Herlev (Dr Vestergaard); Copenhagen City Hearts Study, Copenhagen University Hospital Bispebjerg (Mr Scharling and Dr Jensen), and Department of Cardiology, Copenhagen University Hospital Gentofte (Dr Jensen), Copenhagen, Denmark. The authors have no relevant financial interest in this article.

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