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European Heart Journal Advance Access originally published online on June 16, 2008
European Heart Journal 2008 29(15):1889-1895; doi:10.1093/eurheartj/ehn250
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

The diabetes-cardiovascular risk paradox: results from a Finnish population-based prospective study

Noël C. Barengo1,{dagger},*, Shuichi Katoh1,2,3,4,{dagger}, Vladislav Moltchanov2, Naoko Tajima3 and Jaakko Tuomilehto1,5

1 Department of Public Health, University of Helsinki, PL 41, PO Box 41 (Mannerheimintie 172), 00014 Helsinki, Finland
2 Diabetes and Genetic Epidemiology Unit, Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
3 Division of Diabetes and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
4 Fuji City General Hospital, Fuji, Japan
5 South Ostrobothnia Central Hospital, Seinäjoki, Finland

Received 16 November 2007; revised 30 March 2008; accepted 23 May 2008; online publish-ahead-of-print 16 June 2008.

* Corresponding author. Tel: +358 50 352 08 18, Fax: +358 94 744 86 61, Email: noel.barengo{at}uku.fi

Aims: To assess changes in coronary heart disease (CHD) event rates and CHD mortality rates among diabetic and non-diabetic individuals between two large study cohorts with baseline assessments 10 years apart and followed up for 10 years.

Methods and results: Four population surveys were carried out in 1972, 1977, 1982, and 1987 in a randomly selected independent population in Finland. For the analyses, we combined the 1972 and 1977 cohorts (cohort 1) and similarly also the 1982 and 1987 cohorts (cohort 2). A total of 16 779 men and 18 235 women were followed up for 10 years. Whereas the risk of first cardiovascular disease event in women did not change between the two cohorts, the risk in diabetic men aged 25–49 years and men of all age groups with incidence diabetes during the follow-up decreased compared with the earlier cohort. The relative risk of CHD mortality in men with baseline diabetes or incident diabetes compared with non-diabetic individuals increased (from 1.67 to 1.75 and 1.00 to 1.92, respectively). CHD event rates and CHD mortality rates decreased among non-diabetic individuals between the two study cohorts.

Conclusion: Special attention should be given to prevent the onset of diabetes in the population and to intensify the management of patients with diabetes.

Key Words: Coronary heart disease • Diabetes • Population-based study • Mortality

{dagger} Shared first author contribution.


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