New and known type 2 diabetes as coronary heart disease equivalent: results from 7.6 year follow up in a Middle East population

Abstract

Background: To investigate whether the known diabetes mellitus (KDM) or newly diagnosed diabetes mellitus (NDM) could be regarded as a coronary heart disease (CHD) risk equivalent among a relatively young Middle East population with high prevalence of diabetes mellitus (DM).

Methods: A population based cohort study of 2267 men and 2931 women, aged ≥ 30 years. Prior CHD was defined as self-reported or ECG positive CHD at baseline, KDM as subjects using any kind of glucose-lowering medications and NDM according to fasting plasma glucose and 2-h postchallenge glycemia.Participants were categorized to six groups according to the presence of known or newly diagnosed DM and CHD at baseline (DM-/CHD-, DM-/CHD+, NDM+/CHD-, NDM+/CHD+, KDM+/CHD-, KDM+/CHD+) and Cox regression analysis were used to estimate the hazard ratio (HR) of CHD events for these DM/CHD groups, given DM-/CHD-as the reference.

Results: During 7.6-year follow up, 358 CHD events occurred. After controlling traditional risk factors, HRs of CHD events for DM-/CHD+ group were 2.1 (95% CI: 1.4-3.1) and 5.2 (3.2-8.3) in men and women respectively. Corresponding HRs for NDM+/CHD-were 1.7 (1.1-2.7) and 3.1 (1.8-5.6) and for KDM+/CHD-were 1.7 (0.9-3.3) and 6.2 (3.6-10.6) in men and women respectively. The HRs for NDM+/CHD+ and KDM+/CHD+ groups (i.e. participants with history of both diabetes and CHD) were 6.4 (3.2-12.9) and 8.0 (4.3-14.8) in women and 3.2 (1.9-5.6) and 4.2 (2.2-7.8) in men, respectively.The hazard of CHD events did not differ between KDM+/CHD-and DM-/CHD+ in both genders using paired homogeneity test, however the HR for NDM+/CHD-was marginally lower than the HR for DM-/CHD+ in women (p = 0.085).

Conclusions: KDM patients in both genders and NDM especially in men exhibited a CHD risk comparable to nondiabetics with a prior CHD, furthermore diabetic subjects with prior CHD had the worst prognosis, by far more harmful in women than men; reinforcing the urgent need for intensive care and prophylactic treatment for cardiovascular diseases.

Figure 1

Study participants' entry.

Figure 2

Hazard ratio of CHD event according to baseline DM and prior CHD status. Legend: DM: diabetes mellitus, CHD: coronary heart disease, NDM: newly diagnosed DM, KDM: known DM.