Copyright © 2003 by the European Society of Cardiology.
Regular Articles
Cardiovascular events in type 2 diabetes: comparison with nondiabetic individuals without and with prior cardiovascular disease
10-year follow-up of the Hoorn Study
a Department of Internal Medicine, VU University Medical Center, Amsterdam, Netherlands
b Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, Netherlands
c Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
* Correspondence to: Professor Dr Coen D.A. Stehouwer, Department of Internal Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Tel: +31 20 444 0531; fax: +31 20 444 4313
E-mail address: cda.stehouwer{at}vumc.nl
Received 14 October 2002; revised 6 March 2003; accepted 12 March 2003
Aims 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.
Methods and results 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).
Conclusions 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.
Key Words: Gender • Diabetes mellitus type 2 • Cardiovascular disease • Cardiovascular events • Fatal • Nonfatal
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