Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Apr;31(4):387-93.
doi: 10.1007/s11606-015-3556-3. Epub 2015 Dec 14.

Diabetes and Prior Coronary Heart Disease are Not Necessarily Risk Equivalent for Future Coronary Heart Disease Events

Jamal S Rana  1   2   3   4 , Jennifer Y Liu  5 , Howard H Moffet  5 , Marc Jaffe  6 , Andrew J Karter  5
Affiliations

Diabetes and Prior Coronary Heart Disease are Not Necessarily Risk Equivalent for Future Coronary Heart Disease Events

Jamal S Rana et al. J Gen Intern Med. 2016 Apr.

Abstract

Background: For more than a decade, the presence of diabetes has been considered a coronary heart disease (CHD) "risk equivalent".

Objective: The objective of this study was to revisit the concept of risk equivalence by comparing the risk of subsequent CHD events among individuals with or without history of diabetes or CHD in a large contemporary real-world cohort over a period of 10 years (2002 to 2011).

Design: Population-based prospective cohort analysis.

Participants: We studied a cohort of 1,586,061 adult members (ages 30-90 years) of Kaiser Permanente Northern California, an integrated health care delivery system.

Main measurements: We calculated hazard ratios (HRs) from Cox proportional hazard models for CHD among four fixed cohorts, defined by prevalent (baseline) risk group: no history of diabetes or CHD (None), prior CHD alone (CHD), diabetes alone (DM), and diabetes and prior CHD (DM + CHD).

Key results: We observed 80,012 new CHD events over the follow-up period (~10,980,800 person-years). After multivariable adjustment, the HRs (reference: None) for new CHD events were as follows: CHD alone, 2.8 (95% CI, 2.7-2.85); DM alone 1.7 (95% CI, 1.66-1.74); DM + CHD, 3.9 (95% CI, 3.8-4.0). Individuals with diabetes alone had significantly lower risk of CHD across all age and sex strata compared to those with CHD alone (12.2 versus 22.5 per 1000 person-years). The risk of future CHD for patients with a history of either DM or CHD was similar only among those with diabetes of long duration (≥10 years).

Conclusions: Not all individuals with diabetes should be unconditionally assumed to be a risk equivalent of those with prior CHD.

Keywords: coronary heart disease; diabetes; epidemiology.

PubMed Disclaimer

Conflict of interest statement

Compliance with Ethical Standards Funding Sources This study was supported by a grant from the Kaiser Permanente Northern California Community Benefit Program. Conflict of Interest The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier estimates of coronary heart disease defined by baseline history of diabetes or CHD among four cohorts. The four cohorts are defined as: no diabetes or CHD (None); prior CHD alone (CHD); diabetes alone (DM); diabetes and CHD (DM + CHD), from 2002–2011.
Figure 2
Figure 2
Coronary heart disease rates stratified by sex and age in four cohorts by history of diabetes or CHD. Coronary heart disease rates per 1000 p-y, stratified by sex and age (10-year increments) in four cohorts defined by baseline history of diabetes or CHD: no diabetes or CHD (None); prior CHD alone (CHD); diabetes alone (DM); diabetes and CHD (DM + CHD) A Women, B Men
Figure 3
Figure 3
Risk of CHD by duration of diabetes versus prior CHD. CHD risk among individuals with diabetes alone (DM) by duration of diabetes, versus prior coronary heart disease alone (CHD). Hazard ratios adjusted for same variables as in fully adjusted model 5 in Table 2.
See this image and copyright information in PMC

Comment in

References

    1. American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2012;36:1033–46. - PMC - PubMed
    1. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229–234. doi: 10.1056/NEJM199807233390404. - DOI - PubMed
    1. Executive summary of the third report of the national cholesterol education program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001; 285: 2486–97. - PubMed
    1. Goff DC, Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB, Sr, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC, Jr, Sorlie P, Stone NJ, Wilson PW, American College of Cardiology/American Heart Association Task Force on Practice Guidelines ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American college of cardiology/American heart association task force on practice guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2935–2959. doi: 10.1016/j.jacc.2013.11.005. - DOI - PMC - PubMed
    1. Bulugahapitiya U, Siyambalapitiya S, Sithole J, Idris I. Is diabetes a coronary risk equivalent? systematic review and meta-analysis. Diabet Med. 2009;26:142–148. doi: 10.1111/j.1464-5491.2008.02640.x. - DOI - PubMed

Publication types