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Glycemic Control and the Risk for Coronary Heart Disease in Patients with Non-Insulin-dependent Diabetes Mellitus: The Finnish Studies

Markku Laakso, MD
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From the University of Kuopio, Finland. For the current author address, see end of text. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “Risks and Benefits of Intensive Management in Non-Insulin-dependent Diabetes Mellitus: The Fifth Regenstrief Conference.” To view a complete list of the articles included in this supplement, please view its Table of Contents. Grant Support: From the Medical Research Council of the Academy of Finland. Requests for Reprints: Markku Laakso, MD, Department of Medicine, University of Kuopio 70210, Kuopio, Finland.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(1_Part_2):127-130. doi:10.7326/0003-4819-124-1_Part_2-199601011-00009
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Purpose: To review population-based studies that investigated the association and nature of association between glycemic control and the risk for coronary heart disease in patients with non–insulin-dependent diabetes mellitus (NIDDM).

Data Sources: Study 1 included 133 newly diagnosed patients with NIDDM from eastern Finland, who were 45 to 64 years of age at baseline. These patients were followed up to 10 years for cardiovascular mortality. Study 2 included 229 newly or previously diagnosed patients with NIDDM from eastern Finland, aged 65 to 74 years at baseline. These patients were followed up to 3.5 years for coronary heart disease mortality and all coronary heart disease events (mortality or nonfatal myocardial infarction).

Study Selection: Prospective, population-based studies that included indicators of glycemic control and the evaluation of coronary heart disease and cardiovascular risk.

Results: Study 1: 10-year cardiovascular mortality was significantly and linearly associated with glycemic control (fasting blood glucose and glycated hemoglobin A1 levels) independently of the mode of treatment. A high fasting blood glucose level significantly predicted cardiovascular mortality in multiple logistic regression analysis independently of other risk factors. Study 2: Glycated hemoglobin A1c was the most important single risk factor associated with coronary heart disease death or all coronary heart disease events. In multiple logistic regression analysis, glycated hemoglobin A1c was significantly associated with coronary heart disease death after adjustment for other cardiovascular risk factors.

Conclusions: Two prospective, population-based studies from Finland give evidence for the linear association of glycemic control with the risk for coronary heart disease in middle-aged and elderly patients with NIDDM.


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Figure 2.
The 3.1c1c1c1c

5-year incidence of coronary heart disease deaths and all coronary heart disease events (coronary heart disease death or nonfatal myocardial infarction) by tertile of glycated hemoglobin A (GHbA ) level. Low: less than 6.0%; middle: 6.0% to 7.9%; high: greater than 7.9% (9; drawn on the basis of the original figure, with the permission of the authors and Diabetes). CHD equals coronary heart disease; GHbA equals glycated hemoglobin A .

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Figure 1.
The 10-year cardiovascular mortality by tertiles of fasting blood glucose level at baseline in diet- and drug-treated patients with diabetes.

Low: 8.6 mmol/L or less; middle: 8.7 to 11.8 mmol/L; high: 11.9 mmol/L or more (5; adapted from the original figure with the permission of authors and Diabetologia).

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