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Cardiovascular Mortality Equally Likely for Diabetics as for CVD Patients
By Daniel H. Rasolt
Posted: Thursday, January 08, 2009
(Defeat Diabetes® News) -- Type 2 diabetes and cardiovascular disease (CVD) have been
closely linked in several respects, but little solid quantification of the risk
diabetes poses to cardiovascular mortality has been achieved. A recent study has
made a profound discovery, that in the long-term, mortality due to
cardiovascular events (heart attacks and strokes), is equally likely for
diabetics with no previous cardiovascular disease history, as it is for
individuals with known cardiovascular disease (and non-diabetic). The study was
conducted solely on males, but the results are suspected to extend to both
The connections between cardiovascular disease and diabetes are
numerous. From one angle is the largely supported notion that diabetics are at
higher risk for developing cardiovascular disease. Cardiovascular disease refers
to all diseases associated with one's arteries or veins, but arterial disease
(atherosclerosis) is the most common cardiovascular disease. Atherosclerosis can
range from causing a minor cardiovascular event, such as a minor heart-attack,
to life-threatening strokes and heart-attacks, but is also treatable if caught
in relatively early stages, which unfortunately is rarely the case (diagnosis of
atherosclerosis often comes following a cardiovascular event).
but equally important link between diabetes and cardiovascular disease is their
mutual connection to the rising obesity epidemic. In this case, it's more of a
race to see which disease develops first. Obese individuals are at tremendously
increased risk for both diabetes and cardiovascular disease, so an obese
cardiovascular patient might very well also develop diabetes, and vice versa.
Past research has indicated that having diabetes contributes to the risk
of dying from a cardiovascular event, but the conclusions have been far from
definitive as to how much diabetes really contributes to the fatal
cardiovascular event. The authors of the current study say that in some past
research, "coronary or cardiovascular mortality among people with type 2
diabetes without previous cardiovascular disease was equivalent to that of
people without diabetes who had had a first myocardial infarction or first
cardiovascular event. Thus, there is controversy as to whether diabetes alone
confers a risk of cardiovascular mortality similar to that associated with
having had a first coronary or cardiovascular event."
This statement is also the
foundation for the current study, which aimed to see if diabetics with no
cardiovascular disease history did indeed have an inherent risk of dying from a
cardiovascular event. "The rationale for undertaking the present study was the
need for more information about the cardiovascular prognosis of men with type 2
diabetes relative to men with cardiovascular disease," states the
The researchers had two primary goals and expectations for their
study, both of which were met. The researchers wanted to prove that a diagnosis
of diabetes might not immediately trigger cardiovascular disease, and a
subsequent fatal cardiovascular event, but would indeed often have this effect
in the long run, on a similar level to cardiovascular disease patients.
formulated 2 hypotheses: first, that within the first few years after diagnosis,
the risk of a fatal cardiovascular event would be higher among men with a first
cardiovascular event and no diabetes than among men with type 2 diabetes and no
cardiovascular disease; and second, that over the longer term, the risk of death
within these 2 clinical subsets would tend toward equivalence," says lead author
Dr. Gilles Dagenais and his co-author's.
To confirm their speculations,
the research team analyzed three groups of patients. The initial study
population consisted of 4,376 men between 35 and 64 years of age, who in the
year 1974 did not have cardiovascular disease. The men were tracked for the
following 24 years, in which they were separated into the three groups. Group
one consisted of men with diabetes and no cardiovascular disease (137 men),
group two of non-diabetics with cardiovascular disease (being identified as
having a "first cardiovascular event," such as a myocardial infarction or
stroke), which accounted for 527 men, and those with both diabetes and
cardiovascular disease (18 men).
There was also of course a control group,
consisting of "normal" men with no diabetes or cardiovascular disease (627 men).
The numbers above do not add up to 4,376, which is due to the elimination
throughout the 24 years of the study, of individuals who acquired certain
interfering attributes (such as smoking, or other related diseases), or who died
of other causes or too early to take significant enough measurements (it's noted
that 1,112 men died between 1974 and 1985, and were subsequently eliminated from
the final analysis).
The results were mostly as expected. In the
long-term, which meant following five years after diagnosis, diabetics had a
23.4% likelihood of dying from a cardiovascular event. Similarly, 24.5% of
patients with cardiovascular disease and no diabetes died of cardiovascular
events. This was in comparison with only 6.9% of the controls (no diabetes or
cardiovascular disease), dying from cardiovascular events, demonstrating that
both diabetes and cardiovascular disease, by themselves, represent a three to
four-fold increase in risk of cardiovascular induced mortality.
it's noted that "total mortality," which means death from any cause, was
essentially equivalent between the diabetic and cardiovascular disease groups.
In addition, 38.9% of those men with both diabetes and cardiovascular disease,
died of cardiovascular events, re-enforcing the dangers of these diseases.
Before the five year marker of post-diagnosis for diabetics, which put
the diabetics at similar risk for cardiovascular events as cardiovascular
disease patients, the risk of a cardiovascular death was not nearly as great. In
fact, within the first five years of diabetic diagnosis, those with previous
cardiovascular disease history were approximately twice as likely to die from a
cardiovascular event than the newly diagnosed diabetics. This observation is
most obviously due to the fact that diabetes is a progressive condition, meaning
its effects get worse with time. As was seen above, following the five years,
the differences in cardiovascular mortality risk was minimal between the two
The primary importance of this study is its concrete support of
the belief that diabetes significantly increases the risk of fatal
cardiovascular events. While previously speculated, past research had numerous
discrepancies and limitations. This research clearly demonstrates that having
diabetes not only increases the risk of cardiovascular disease and
cardiovascular death, but increases it to such a level that it is as likely for
a diabetic to die from a cardiovascular event as it is for someone with
Type 2 diabetes is a disease of epic proportions,
effecting more than 24 million adults in the United States, and hundreds of
millions more world wide. Aso, in the U. S. there are more than 57 million people at risk for type 2 diabetes. Cardiovascular events are known to be the leading
cause of death throughout the world, but especially so in the United States
(accounting for approximately 35% of deaths). The above demonstrated connection
between type 2 diabetes and cardiovascular mortality, along with rising numbers
of diabetics, spells big trouble for the future.
Fortunately, type 2 diabetes is
often preventable, as well as manageable, with proper exercise and nutrition and regular medical checkups.
Awareness and initiative taken against diabetes is the only hope for stemming
the tide of rising diabetes incidence, and of course subsequent diabetes induced
Source: Defeat Diabetes Foundation: Dagenais, Gilles. St.-Pierre, Annie. Bogaty, Peter. et al. Canadian Medical Association Journal. "Comparison of prognosis for men with type 2 diabetes mellitus and men with cardiovascular disease." January 2009.
Daniel H. Rasolt writes for Defeat Diabetes® News. Read more of his original content articles.
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