Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2007;60:1167-76 - Vol. 60 Num.11 DOI: 10.1016/S1885-5857(08)60047-X

Is Diabetes Mellitus a Coronary Heart Disease Equivalent? Results of a Meta-Analysis of Prospective Studies

José Miguel González-Clemente a, Silvia Palma b, Jaume Arroyo a, Carme Vilardell a, Assumpta Caixàs a, Olga Giménez-Palop a, Miguel Delgado-Rodríguez b

a Servicio de Diabetes, Endocrinología y Nutrición, Hospital de Sabadell, Sabadell, Barcelona, Spain
b Departamento de Medicina Preventiva y Salud Pública, Universidad de Jaén, Jaén, Spain

Keywords

Coronary heart disease. Cardiovascular disease. Diabetes mellitus. Meta-analysis. Coronary heart disease equivalent.

Abstract

Introduction and objectives. Several guidelines on the treatment of cardiovascular risk factors base their recommendations on the assertion that diabetes mellitus (DM) is a coronary heart disease (CHD) or cardiovascular disease (CVD) risk equivalent. To date, no systematic review of studies substantiating this assertion has been carried out. Methods. A systematic search of the PubMed database up to February 2006 was performed to identify prospective studies meeting the following criteria: a) follow-up was >5 years; b) groups of subjects with DM and without CHD (i.e., DM+CHD-), without DM and with CHD (DM-CHD+), and without either DM or CHD (DM-CHD-) were all included; and c) data on CHD or CVD mortality was reported. The characteristics of the studies were assessed, and data were combined separately for men and women using a random effects model and taking the DM-CHD- group as a reference. Results. In total, 13 studies met the inclusion criteria. Overall, CHD mortality was non-significantly lower in DM+CHD- men than in DM-CHD+ men, hazard ratio [HR] (95% confidence interval [CI]), 3.06 (2.45-3.83) vs 4.28 (3.24-5.66), respectively (P=.066); as was CVD mortality, HR (95% CI), 2.55 (2.00-3.26) vs 3.61 (2.81-4.62), respectively (P=.051). In women, there was no significant difference between the DM+CHD- and DM-CHD+ groups with regard to either CHD mortality, HR (95% CI), 4.68 (3.40-6.45) vs 3.51 (1.75-7.04), respectively (P=.42), or CVD mortality, HR (95% CI), 4.70 (4.23-5.22) vs 3.39 (1.51-9.02), respectively (P=.59). Conclusions. The findings of this meta-analysis support the view that women in the DM+CHD- group have similar CHD and CVD mortality to those in the DM-CHD+ group, whereas men in the DM+CHD- group demonstrated a non-significant trend towards lower CHD and CVD mortality than those in the DM-CHD+ group.

1885-5857/© 2007 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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