In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

The impact of diabetes and myocardial infarction on mortality from coronary heart disease

An article from the e-journal of the ESC Council for Cardiology Practice

Type 2 diabetes is one of the fastest growing public health problems in both developed and developing countries (1).
Coronary heart disease (CHD) is the leading cause of death among patients with type 2 diabetes (2).
Epidemiological studies have indicated that patients with type 2 diabetes have a 2-4 times higher risk of CHD mortality than those without diabetes. In recent years, several studies compared the magnitude of the risk of prior history of type 2 diabetes and CHD on subsequent CHD mortality (3-8).
The analyses from a Finnish cohort study including both men and women (3) and from the Nurses’ Health Study including women only (5) found that the risk of CHD among diabetic patients without prior myocardial infarction was similar to that in non-diabetic subjects with prior myocardial infarction.
The result from the Health Professionals Follow-up Study including men only and the Atherosclerosis Risk in Communities Study including both men and women (8), reported that the magnitude for CHD or cardiovascular disease (CVD) mortality was weaker for diabetes than that associated with prior CHD (4, 8).
It is well known that women with diabetes will loose their relative protection against CVD (9). However, only two studies comprising both men and women attempted to find out whether sex differences in the risk for CHD mortality existed in patients with diabetes by comparing it with established CHD (6, 7). The analysis from the Framingham Study indicated that in men prior CHD signifies a higher risk for CHD mortality than prior diabetes (6).
However, this is reversed in women, with prior diabetes being associated with greater risk for CHD mortality (6). In the Hoorn Study, women with prior diagnosis of diabetes only had a risk of CVD events that was similar to that of non-diabetic women with prior CVD, whereas, non-diabetic men with prior CVD conferred a higher risk of CVD compared with men with prior diabetes and without prior CVD (7).
These studies found that both diabetes and myocardial infarction at baseline increased CVD mortality. Further research is needed to compare the impact of incident diabetes and myocardial infarction at baseline and during follow-up on CHD mortality among both men and women.

 The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.


1. King H, Aubert RE, Herman WH. Global Bruden of Diabetes, 1995-2025: Prevalence, numerical estimates, and projections. Diabetes Care 1998;21:1414-31.

2. Muller WA. Diabetes mellitus--long time survival. J Insur Med 1998;30:17-27.

3. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998;339:229-34.

4. Hu FB, Stampfer MJ, Solomon CG, et al. The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women: 20 years of follow-up. Arch Intern Med 2001;161:1717-23.

5. Lotufo PA, Gaziano JM, Chae CU, et al. Diabetes and all-cause and coronary heart disease mortality among US male physicians. Arch Intern Med 2001;161:242-7.

6. Natarajan S, Liao Y, Cao G, Lipsitz SR, McGee DL. Sex differences in risk for coronary heart disease mortality associated with diabetes and established coronary heart disease. Arch Intern Med 2003;163:1735-40.

7. Becker A, Bos G, de Vegt F, et al. Cardiovascular events in type 2 diabetes: comparison with nondiabetic individuals without and with prior cardiovascular disease. 10-year follow-up of the Hoorn Study. Eur Heart J. 2003;24:1406-13.

8. Lee CD, Folsom AR, Pankow JS, Brancati FL. Cardiovascular events in diabetic and nondiabetic adults with or without history of myocardial infarction. Circulation 2004;109:855-60.

9. DECODE Study Group. Gender difference in all-cause and cardiovascular mortality related to hyperglycaemia and newly-diagnosed diabetes. Diabetologia 2003;46:608-17.


Notes to editor

G. Hu and J. Tuomilehto
Helsinki, Finland
Senior Researcher and Professor

Diabetes and Genetic Epidemiology Unit
Department of Epidemiology and Health Promotion
National Public Health Institute
and Department of Public Health
University of Helsinki
Mannerheimintie 166
00300 Helsinki, Finland

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.