Coronary heart disease risk equivalence in diabetes depends on concomitant risk factors

OBJECTIVE — Diabetes has been defined as a coronary heart disease (CHD) risk equivalent, and more aggressive treatment goals have been proposed for diabetic patients. RESEARCH DESIGN AND METHODS — We studied the influence of single and multiple risk factors on the 10-year cumulative incidence of fatal and nonfatal CHD and cardio-vascular disease (CVD) in diabetic and nondiabetic men and women, with and without baseline CHD or CVD, in a population (n 4,549) with a high prevalence of diabetes. RESULTS — In both sexes, diabetes increased the risk for CHD (hazard ratio 1.99 and 2.93 for men and women, respectively). Diabetic men and women had a 10-year cumulative incidence of CHD of 25.9 and 19.1%, respectively, compared with 57.4 and 58.4 % for nondiabetic men and women with previous CHD. The pattern was similar when only fatal events were considered. Diabetic individuals with one or two risk factors had a 10-year cumulative incidence of CHD that was only 1.4 times higher than that of nondiabetic individuals (14%). However, the 10-year incidence of CHD in diabetic subjects with multiple risk factors was40%, and the incidence of fatal CHD was higher in these subjects than in nondiabetic subjects with previous CHD. Data for CVD showed similar patterns, as did separate analyses by sex