GENERAL CARDIOLOGY: Diabetic heart disease: clinical considerations

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Abstract
Three large epidemiological studies have shaped current understanding of the natural history of diabetic heart disease. The Framingham study showed that diabetes increased the relative risk of coronary heart disease by 66% in men and 203% in women followed up for 20 years, after controlling for the effects of age, smoking, blood pressure, and cholesterol.1 The Whitehall study of male civil servants extended these observations by showing that subclinical glucose intolerance, in addition to frank diabetes, also increased coronary risk.2 The MRFIT trial, with its very large population of middle aged men, was able to provide more detailed information about the interaction between diabetes and other risk factors in determining coronary risk.3 This trial confirmed the heightened risk attributable to diabetes, and also the independent effects of serum cholesterol, blood pressure, and smoking in men with and without diabetes. MRFIT showed that in men with diabetes, 12 year cardiovascular mortality was much higher at every level of these major risk factors considered singly and in combination, and that with progressively more unfavourable risk factor status the mortality rate rose much more steeply than in men without diabetes (fig1).