European Heart Journal Advance Access originally published online on November 2, 2007
European Heart Journal 2007 28(24):3059-3066; doi:10.1093/eurheartj/ehm501
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Joint effects of history of hypertension at baseline and type 2 diabetes at baseline and during follow-up on the risk of coronary heart disease
1 Department of Health Promotion and Chronic Diseases Prevention, National Public Health Institute, Helsinki, Finland
2 Department of Public Health, University of Helsinki, Helsinki, Finland
3 Tampere School of Public Health, University of Tampere, Tampere, Finland
4 South Ostrobothnia Central Hospital, Seinäjoki, Finland
Received 26 February 2007; revised 17 September 2007; accepted 4 October 2007; online publish-ahead-of-print 2 November 2007.
* Corresponding author. Tel: +358 9 19127366; fax: +358 9 19127313. E-mail address: hu.gang{at}ktl.fi
Aims: To evaluate the joint associations of history of hypertension at baseline and type 2 diabetes at baseline and during follow-up on the incidence of coronary heart disease (CHD) and CHD mortality.
Methods and results: Study cohorts included 49 775 Finnish subjects aged 25–74 without history of CHD and stroke. The multivariable-adjusted hazard ratios (HRs) of CHD incidence were 1.25, 1.69, 1.25, 1.83, 1.85, 2.39, 2.15, and 3.31 (P-value for trend <0.001), respectively, among men with hypertension I (blood pressure 140–159/90–94 mmHg or using antihypertensive drugs at baseline but blood pressure <160/95 mmHg) only, with hypertension II (blood pressure 
160/95 mmHg) only, with incident diabetes during follow-up only, with both hypertension I and incident diabetes, with both hypertension II and incident diabetes, with history of diabetes at baseline only, with both hypertension I and history of diabetes, and with both hypertension II and history of diabetes compared with men without either of these diseases. The corresponding HRs of CHD incidence among women were 1.52, 2.37, 2.45, 3.78, 4.56, 5.63, 6.10, and 7.41 (P-value for trend <0.001), respectively. The impact on CHD mortality associated with the different strata of hypertension and diabetes was almost the same or a little stronger compared with that on the CHD incidence.
Conclusion: Hypertension and type 2 diabetes increase the CHD risk independently, and their combination increases the risk dramatically, particularly in women.
Key Words: Coronary heart disease • Diabetes mellitus • Hypertension