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May 24, 1999

Type 2 Diabetes Mellitus: Greater Cardiovascular Risks and Greater Benefits of Therapy

Arch Intern Med. 1999;159(10):1033-1034. doi:10.1001/archinte.159.10.1033

TYPE 2 DIABETES MELLITUS is associated with a 2- to 3-fold increased risk of cardiovascular morbidity and mortality. The risk is approximately 2-fold in men and 4-fold in women.1 The risk of coronary disease is increased 4-fold in diabetic persons compared with nondiabetic persons, and the risks of myocardial infarction (MI) and death from coronary disease are the same in diabetic persons without previous MI as in nondiabetic persons with previous MI.2 The relative risk of stroke in diabetic persons is 2- to 3-fold the risk in nondiabetic persons, and there is a greater relative increased risk in women compared with men.3,4 In this issue of the ARCHIVES, Davis et al, reporting 8 years of observation for the United Kingdom Prospective Diabetes Study (UKPDS) Group,4 document the increased risk of stroke in diabetic persons, which is associated with hypertension or higher systolic blood pressure (BP), regardless of whether BP is measured in treated or untreated persons. Even persons in the middle tertile, with systolic BP of 125 to 142 mm Hg, had twice as high a risk of stroke as persons with lower systolic BP.4 Results of these2-4 and other studies5-13 show that diabetic persons are at higher risk than nondiabetic persons. Yet, what is the evidence that treatment of risk factors such as hypertension and hyperlipidemia decreases morbidity and mortality?