Impact of Diabetes and Previous Myocardial Infarction on Long-term Survival25-Year Mortality Follow-up of Primary Screenees of the Multiple Risk Factor Intervention Trial

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Abstract
Diabetes mellitus is widely recognized as a strong independent risk factor for coronary heart disease (CHD). Several epidemiologic studies have confirmed that men with diabetes are 2 to 3 times more likely to die from CHD than those without diabetes and that the risk is even higher in women.1-5 Prior myocardial infarction (MI) is also a strong risk factor for coronary and cardiovascular disease (CVD) mortality.6 Expert groups have recommended that CHD-CVD prevention in all patients with diabetes include measures as vigorous as those for people with a prior MI,7-9 implying that the 2 conditions have a similar impact on risk. However, whether the excess cardiovascular risk conferred by diabetes rivals that of a previous MI has been explored only to a limited extent10-14 and with apparently inconsistent results. One investigation reported that diabetes and previous CHD were equally strong predictors of both CHD and all-cause mortality,10 but this conclusion has been challenged by results of later studies.12-14 The modulating roles of age, major cardiovascular risk factors, and duration of follow-up have been incompletely explored and may partly explain discrepancies. Furthermore, there is evidence that risk of noncardiovascular mortality is also increased in people with diabetes,15-17 but limited information exists on the comparative associations of MI and diabetes with noncardiovascular mortality. Clarifying these issues might provide evidence for enhanced risk stratification and preventive strategies.