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June 1991

A Prospective Study of Maturity-Onset Diabetes Mellitus and Risk of Coronary Heart Disease and Stroke in Women

Author Affiliations

From the Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital (Drs Manson, Colditz, Stampfer, Willett, Rosner, Speizer, and Hennekens), the Department of Preventive Medicine, Harvard Medical School (Drs Manson, Rosner, and Hennekens), the Departments of Epidemiology (Drs Stampfer, Willett, and Krolewski and Nutrition (Dr Willett), Harvard School of Public Health, and the Joslin Diabetes Center (Dr Krolewski), Boston, Mass; and Mount Auburn Hospital, Cambridge, Mass (Dr Arky).

Arch Intern Med. 1991;151(6):1141-1147. doi:10.1001/archinte.1991.00400060077013

We examined the relationship of maturity-onset clinical diabetes mellitus with the subsequent incidence of coronary heart disease, stroke, total cardiovascular mortality, and all-cause mortality in a cohort of 116177 US women who were 30 to 55 years of age and free of known coronary heart disease, stroke, and cancer in 1976. During 8 years of follow-up (889 255 personyears), we identified 338 nonfatal myocardial infarctions, 111 coronary deaths, 259 strokes, 238 cardiovascular deaths, and 1349 deaths from all causes. Diabetes was associated with a markedly increased risk of nonfatal myocardial infarction and fatal coronary heart disease (age-adjusted relative risk [RR] = 6.7; 95% confidence interval [CI], 5.3 to 8.4), ischemic stroke (RR = 5.4; 95% CI, 3.3 to 9.0), total cardiovascular mortality (RR 6.3; 95% CI, 4.6 to 8.6), and all-cause mortality (RR 3.0; 95% CI, 2.5 to 3.7). A major independent effect of diabetes persisted in multivariate analyses after simultaneous control for other known coronary risk factors (for these end points, RR [95% CI] = 3.1 [2.3 to 4.2], 3.0 [1.6 to 5.7], 3.0 [1.9 to 4.8], and 1.9 [1.4 to 2.4], respectively). The absolute excess coronary risk due to diabetes was greater in the presence of other risk factors, including cigarette smoking, hypertension, and obesity. These prospective data indicate that maturity-onset clinical diabetes is a strong determinant of coronary heart disease, ischemic stroke, and cardiovascular mortality among middle-aged women. The adverse effect of diabetes is amplified in the presence of other cardiovascular risk factors, many of which are modifiable.

(Arch Intern Med. 1991;151:1141-1147)