33^rd European Diabetes Congress

Cardiovascular risk in Type 2 Diabetes

The risk of CVD mortality in type 2 diabetic patients is more than double compared with that in age-matched subjects. Stroke events and all manifestations of CHD, myocardial infarction (MI), sudden death, and angina pectoris is at least twofold more common in patients with type 2 diabetes than in non-diabetic individuals. A high proportion of patients with type 2 diabetes die after an acute MI within 1 year, and a considerable number of patients die outside the hospital. Relative risk for CHD events is higher in female patients with type 2 diabetes than in male patients with type 2 diabetes. The reason for the sex difference is largely unknown but could be at least in part explained by a heavier risk-factor burden and a greater effect of blood pressure and atherogenic dyslipidemia on the risk of CVD in diabetic women than in diabetic men.

The prognosis of patients with type 2 diabetes is highly dependent on the presence of CVD. We compared the 7-year incidence of fatal and nonfatal MI among 1,373 non-diabetic subjects with the incidence among 1,059 subjects with type 2 diabetes. Our study suggested that patients with type 2 diabetes without previous MI have as high a risk of MI as non-diabetic patients with previous MI. Thus, our results indicated that type 2 diabetes is a “coronary heart disease equivalent.” These results were recently replicated by an 18-year follow-up study of our original cohort and by a Danish study including 3.3 million subjects. One of the paradoxes in the studies of cardiovascular complications in type 2 diabetes is that at diagnosis individuals with type 2 diabetes already has substantially increased prevalence of CHD and stroke.