Prognosis after initial myocardial infarction: the Framingham study.

During 20 years of follow-up of 5,127 men and women initially free of coronary heart disease in the Framingham cohort, 193 men and 53 women had one or more recognized, symptomatic myocardial infarctions. An additional 45 men and 28 women had unrecognized myocardial infarctions. Subsequent mortality and morbidity including angina, reinfarction, congestive failure and sudden death were ascertained. One in five men who had a first myocardial infarction died within 1 year, a mortality rate 14 times that of those free of coronary heart disease. In men who survived the 1st year, a recognized myocardial infarction increased risk of death over the next 5 years to 23 percent, four times that of the general population. The next 5 years carried a 25 percent mortality (three times that of the general population). The prognosis was distinctly worse in women than in men chiefly because of a higher (45 percent) early mortality rate in women. Patients with recognized and unrecognized myocardial infarctions had similar survival rates after 3 years. A second myocardial infarction occurred in 13 percent of the men and in 40 percent of the women within 5 years of the first infarction. Thus, women were more prone to death and reinfarction than men. Congestive heart failure occurred as commonly as reinfarction, affliction 14 percent of the men within 5 years of the initial infarction. Once congestive failure ensued, half of the affected patients were dead within 5 years. Angina developed in one third of the patients within 5 years of their first infarction.     

Myocardial infarction in diabetic and non-diabetic persons with and without prior myocardial infarction: the FINAMI Study

Aims/hypothesis We compared the risk of acute coronary events in diabetic and non-diabetic persons with and without prior myocardial infarction (MI), stratified by age and sex. Methods A Finnish MI-register study known as FINAMI recorded incident MIs and coronary deaths (n=6988) among people aged 45 to 74 years in four areas of Finland between 1993 and 2002. The population-based FINRISK surveys were used to estimate the numbers of persons with prior diabetes and prior MI in the population. Results Persons with diabetes but no prior MI and persons with prior MI but no diabetes had a markedly greater risk of a coronary event than persons without diabetes and without prior MI. The rate of recurrent MI among non-diabetic men with prior MI was higher than the incidence of first MI among diabetic men aged 45 to 54 years. The rate ratio was 2.14 (95% CI 1.40–3.27) among men aged 50. Among elderly men, diabetes conferred a higher risk than prior MI. Diabetic women had a similar risk of suffering a first MI as non-diabetic women with a prior MI had for suffering a recurrent MI. Conclusions/interpretation Both persons with diabetes but no prior MI, and persons with a prior MI but no diabetes are high-risk individuals. Among men, a prior MI conferred a higher risk of a coronary event than diabetes in the 45–54 year age group, but the situation was reversed in the elderly. Among diabetic women, the risk of suffering a first MI was similar to the risk that non-diabetic women with prior MI had of suffering a recurrent MI.     

Gender influence on hospital mortality after coronary artery bypass surgery

There is still controversy about the influence of gender on hospital mortality after coronary artery bypass grafting. We analyzed various risk factors in 1,258 patients undergoing isolated on-pump coronary artery bypass, of whom 19 (1.5%) died in hospital. There were 937 men (74.5%) and 321 women (25.5%). Compared to men, women were older with a higher mean body mass index, twice as many were hypertensive and diabetic, and they had higher serum cholesterol and triglycerides. Men smoked more, had lower ejection fractions, more myocardial infarctions and poorer functional status. Female sex, congestive heart failure, low ejection fraction, diabetes, previous percutaneous interventions and chronic lung disease were more prevalent among the patients who died. These factors were used to form a logistic regression model in which sex did not have an independent influence on hospital mortality. The difference between men and women can be explained by differences in risk factor profile.     

The relationship of cardiovascular risk factors to the prevalence of coronary heart disease in newly diagnosed Type 2 (non-insulin-dependent) diabetes

Summary The relationship of cardiovascular risk factors to the prevalence of coronary heart disease was examined in 133 newly diagnosed Type 2 (non-insulin-dependent) diabetic patients (70 men, 63 women) aged from 45 to 64 years and in 144 randomly selected non-diabetic control subjects (62 men, 82 women) of the same age. The prevalence of coronary heart disease in diabetic patients, defined by symptoms and ischaemic ECG abnormalities in resting or exercise ECG, was more than threefold that in non-diabetic subjects. In multiple logistic analyses (including age, history of smoking, hypertension (+/-), serum cholesterol, HDL-cholesterol, triglycerides, 2-h post-glucose serum insulin, body mass index and diabetes (+/-)) carried out separately for men and women, diabetes showed an independent, significant association to coronary heart disease in both sexes. In addition, age and hypertension had a borderline association to coronary heart disease in men, whereas smoking and high 2-h postglucose serum insulin level showed a significant association in women.     

Incidence of cardiovascular disease in Type 1 (insulin-dependent) diabetic subjects with and without diabetic nephropathy in Finland

Summary This study evaluates the impact of diabetic nephropathy on the incidence of coronary heart disease, stroke and any cardiovascular disease in the Finnish population, which has a high risk of Type 1 (insulin-dependent) diabetes mellitus and cardiovascular disease. We performed a prospective analysis of the incidence of coronary heart disease, stroke and cardiovascular disease in all Type 1 subjects in the Finnish Type I diabetes mellitus register diagnosed before the age of 18 years between 1 January 1965 and 31 December 1979 nationwide. The effect of age at onset of diabetes, attained age at the end of follow-up, sex, diabetes duration and of the presence of diabetic nephropathy on the risk for cardiovascular disease was evaluated. Cases of nephropathy, coronary heart disease, stroke and all cardiovascular diseases were ascertained from the nationwide Finnish Hospital Discharge Register and National Death Register using computer linkage with the Type I diabetes mellitus register. Of the 5148 Type 1 diabetic patients followed up, 159 had a cardiovascular event of which 58 were coronary heart diseases, 57 stroke events and 44 other heart diseases. There were virtually no cases of cardiovascular disease before 12 years diabetes duration. The cumulative incidence of cardiovascular disease by the age of 40 years was 43 % in Type 1 diabetic patients with diabetic nephropathy, compared with 7 % in patients without diabetic nephropathy, similarly in men and women. The relative risk for Type 1 diabetic patients with diabetic nephropathy compared with patients without diabetic nephropathy was 10.3 for coronary heart disease, 10.9 for stroke and 10.0 for any cardiovascular disease, similarly in men and women. The presence of nephropathy in Type I diabetic subjects increases not only the risk of coronary heart disease, but also of stroke by tenfold. [Diabetologia (1998) 41: 784–790] Received: 14 August 1997 and in final revised form: 2 March 1998     

Epidemiology of some peripheral arterial findings in diabetic men and women: experiences from the Framingham Study

PURPOSE AND PATIENTS AND METHODS: The purpose of this study was to determine the relationship between diabetes and the development of some peripheral arterial findings--carotid and femoral bruits and nonpalpable pedal pulse--and acute cardiovascular events in 1,196 men and 1,582 women based on 20-year follow-up data in the Framingham Study. RESULTS: For both men and women without diabetes, the incidence of carotid bruits and nonpalapble pedal pulses increased significantly with age (p less than 0.05) without any apparent male predominance. In contrast, diabetic men and women were at an elevated risk of each peripheral arterial condition that was not appreciably different across age groups. Compared with women without diabetes, those with diabetes experienced nearly a twofold excess of femoral bruits (p less than 0.05) and a 50% excess of nonpalpable pedal pulses (p less than 0.01). Among men, diabetes nearly doubled the risk of carotid bruits (p less than 0.05). Those who had both diabetes and symptoms of peripheral arterial disease were at especially high risk of incident cardiovascular events. In particular, nonpalpable pedal pulses were associated with more than a twofold excess of coronary heart disease (p less than 0.05) and stroke (p less than 0.01) in diabetic women and more than a twofold excess of coronary heart disease and cardiac failure in diabetic men (p less than 0.01). Femoral bruits doubled the risk of coronary heart disease in diabetic men (p less than 0.05). CONCLUSION: We conclude that while diabetes predisposes to various forms and locations of peripheral arterial disease, the enhanced risk of acute cardiovascular events experienced by diabetic patients is increased further when diabetes is accompanied by indications of a peripheral arterial condition. Since signs of peripheral arterial disease may suggest an impending or coexistent atherosclerotic process, careful examination of arterial circulation by evaluating peripheral pulses and assessing whether bruits are present is important.     

Comparative features of newly acquired left and right bundle branch block in the general population: the Framingham study

Cardiovascular abnormalities were prospectively identified in all 55 persons who acquired left bundle branch block and all 70 persons who acquired right bundle branch block during 18 years of follow-up of the Framingham Study cohort. Those with left and right bundle branch block did not differ from each other in the overall prevalence of either hypertension, clinical coronary disease or diabetes. In men, but not in women, left bundle branch block was associated with a significantly greater prevalence of cardiac enlargement and congestive failure than was right bundle branch block. A trend suggesting a higher mortality rate from cardiovascular disease in those with left than in those with right bundle branch block was more apparent in men than in women. It is concluded that in the general adult population, men who acquire left bundle branch block are more likely to have or subsequently acquire advanced cardiovascular abnormalities than are men who acquire right bundle branch block. In women, however, the clinical correlates of the two conduction abnormalities are similar.     

Mortality, mode of death and risk indicators for death during 5 years after coronary artery bypass grafting among patients with and without a history of diabetes mellitus

OBJECTIVE: To describe mortality, mode of death, risk indicators for death and symptoms of angina pectoris among survivors during 5 years after coronary artery bypass grafting (CABG) among patients with and without a history of diabetes mellitus. METHODS: All patients in western Sweden who underwent CABG without concomitant valve surgery and who had no previous CABG between June 1988 and June 1991 were entered prospectively in this study. After 5 years, information on deaths that had occurred was obtained for the analysis. RESULTS: In all, 1998 patients were included in the analysis; 242 (12%) had a history of diabetes. Among the non-diabetic patients, 5-year mortality was 12.5%; the corresponding relative risk for diabetic patients was 2.1 (95% confidence interval 1.6 to 2.9). A history of diabetes was an independent risk indicator of death; there was no significant interaction between any other risk indicator and diabetes. Independent risk indicators for death among diabetic patients were: current smoking, renal dysfunction and left ventricular ejection fraction < 0.40. Compared with non-diabetic patients, those with diabetes more frequently died in hospital, died a cardiac death, or had death associated with the development of acute myocardial infarction and with symptoms of congestive heart failure. Among survivors, diabetic patients tended to have more angina pectoris 5 years after CABG than did those without diabetes. CONCLUSION: During a period of 5 years after CABG, diabetic patients had a mortality twice that of non-diabetic patients. The increased risk included death in hospital, cardiac death and death associated with development of acute myocardial infarction and with symptoms of congestive heart failure.     

The effect of type 1 diabetes mellitus on the gender difference in coronary artery calcification

OBJECTIVES

To examine whether the gender difference in coronary artery calcification, a measure of atherosclerotic plaque burden, is lost in type 1 diabetic patients, and whether abnormalities in established coronary heart disease risk factors explain this.

BACKGROUND

Type 1 diabetes abolishes the gender difference in coronary heart disease mortality because it is associated with a greater elevation of coronary disease risk in women than men. The pathophysiological basis of this is not understood.

METHODS

Coronary artery calcification and coronary risk factors were compared in 199 type 1 diabetic patients and 201 nondiabetic participants of similar age (30 to 55 years) and gender (50% female) distribution. Only one subject had a history of coronary disease. Calcification was measured with electron beam computed tomography.

RESULTS

In nondiabetic participants there was a large gender difference in calcification prevalence (men 54%, women 21%, odds ratio 4.5, p < 0.001), half of which was explained by established risk factors (odds ratio after ADJUSTMENT = 2.2). Diabetes was associated with a greatly increased prevalence of calcification in women (47%), but not men (52%), so that the gender difference in calcification was lost (p = 0.002 for the greater effect of diabetes on calcification in women than men). On adjustment for risk factors, diabetes remained associated with a threefold higher odds ratio of calcification in women than men (p = 0.02).

CONCLUSIONS

In type 1 diabetes coronary artery calcification is greatly increased in women and the gender difference in calcification is lost. Little of this is explained by known coronary risk factors.     

Cardiac transplantation in patients with insulin-treated diabetes mellitus.

BACKGROUND AND METHODS: As documented earlier the incidence of cardiac mortality in diabetic patients due to coronary artery disease is high. Cardiac transplantation for congestive heart failure due to coronary artery disease, cardiomyopathy, and valvular diseases is obviously a therapeutic option in patients suffering from insulin-treated diabetes mellitus. To shed more light on this problem we performed a retrospective analysis of 40 patients with insulin-treated diabetes mellitus (three type-1; 37 type-2: insulin-treated for at least three months before cardiac transplantation) referred to our transplant unit for cardiac transplantation between March 1989 and December 1996. RESULTS: Orthotopic cardiac transplantation was performed in 40 patients (4 women, 36 men) aged 32-73 years (mean 56 years) with an insulin-treated diabetes mellitus preexisting for 3-348 months (mean 65.1 months). Donor age ranged from 15 to 72 years (mean 35.5 years) matched for body weight and blood group. Overall mortality in this group was 40.0% with an early mortality of 12.5%. CONCLUSIONS: Our results show that type-1/2 insulin-treated diabetes mellitus preoperative to heart transplantation is not a contraindication in patients suffering from end-stage heart failure. Adequate therapy of diabetes mellitus as well as individual immunosuppressive therapy are important in order to minimize additional organ damage caused by the drugs themselves or resulting infectious complications.     

Heart disease in diabetic patients

Both type 1 and type 2 diabetic patients have an increased incidence of ischemic heart disease and congestive heart failure. Cardiovascular disease accounts for up to 80% of the excess mortality in patients with type 2 diabetes. The burden of cardiovascular disease is especially pronounced in diabetic women. Factors that underlie diabetic heart disease include multiple vessel coronary artery disease, long-standing hypertension, metabolic derangements such as hyperglycemia and dyslipidemia, microvascular disease, and autonomic neuropathy. There is also increased sudden death associated with diabetes, which is due, in part, to the underlying autonomic neuropathy. This article reviews diabetic cardiac disease, with an emphasis on type 2 diabetes.     

Cardiac failure and sudden death in the Framingham Study

Mortality is examined in patients with cardiac failure in the Framingham study of 5209 subjects. During 30 years of follow-up, the incidence of cardiac failure doubled with each decade of age with a male predominance produced by higher rates of coronary heart disease. Most cardiac failure was associated with hypertension or coronary heart disease. Among 232 men and 229 women in whom cardiac failure developed, sudden death occurred at nine times the general age-adjusted population rate. Cardiac failure alone increased the risk of sudden death fivefold. In those who also had coronary heart disease there was a further doubling of risk. The major predisposing factors for cardiac failure included hypertension, obesity, glucose intolerance, heavy smoking, cardiac enlargement, ECG abnormality, and atrial fibrillation. These were also risk factors for sudden death. These shared modifiable risk factors and cardiac impairments did not entirely account for the markedly increased risk of sudden death in cardiac failure. This suggest that either the damaged myocardium or treatment needed to control the cardiac failure may be at fault.     

The heart in massive (more than 300 pounds or 136 kilograms) obesity: analysis of 12 patients studied at necropsy

Observations are described in 12 massively obese patients (5 women, 7 men), aged 25 to 59 years (mean 37), who weighed 312 to more than 500 pounds (mean 381). Seven patients had had systemic hypertension, 4 hypersomnia or sleep apnea, 2 diabetes mellitus, and 1 patient symptomatic coronary artery disease. Five patients died suddenly from undetermined causes, 2 from right-sided congestive heart failure, 1 patient from acute myocardial infarction; 1 from aortic dissection; 1 from intracerebral hemorrhage; 1 from a drug overdose, and 1 soon after an ileal bypass. The heart weight was increased in all 12 patients. The heart weight to body weight ratio expressed as a percent ranged from 0.22 to 0.61 (mean 0.37) (normal for men 0.42 to 0.46 [mean 0.43], normal for women 0.38 to 0.46 [mean 0.40]). The left ventricular cavity was dilated in 11 patients and the right ventricular cavity in all 12. Only 2 patients (aged 42 and 59 years) had 1 or more major epicardial coronary arteries narrowed greater than 75% in cross-sectional area by atherosclerotic plaque, 1 of whom had no symptoms of myocardial ischemia. Of 664 five-millimeter segments from the 4 major epicardial coronary arteries from 11 patients (mean 60 per patient), 431 (65%) were narrowed 0 to 25% in XSA, 143 (21%) were narrowed 26 to 50%, 73 (11%) were narrowed 51 to 75%, and 17 (3%) were narrowed 76 to 100%.(ABSTRACT TRUNCATED AT 250 WORDS)     

糖尿病合并非ST段抬高急性冠状动脉综合征患者的临床特点、治疗及远期预后

目的 了解糖尿病合并非ST段抬高急性冠状动脉综合征(ACS)患者的临床特点、治疗及远期预后.方法 在我国北方38个中心连续入选因非ST段抬高ACS住院的患者,记录既往病史、入院情况、住院期间主要治疗和心血管事件,并在发病6、12和24个月对所有患者进行随访.采用Kaplan-Meier牛存分析比较糖尿病和非糖尿病患者2年累计事件发生率,Cox回归多因素分析用于2年累计死亡影响因素的识别.结果 共注册非ST段抬高ACS住院患者2294例,其中已知糖尿病患者420例,占18.3%.平均年龄(64.9±6.7)岁,高于非糖尿病患者的(62.3±8.6)岁(P<0.01),女性患者(占48.1%)、既往有高血压病、心肌梗死、心力衰竭、卒中者均多于非糖尿病患者.合并糖尿病患者住院期间抗血小板约物的应用(92.1%比95.0%,P<0.05)、接受冠状动脉造影(30.0%比36.3%,P<0.05)和冠状动脉介入治疗(12.1%比18.8%,P<0.05)的患者少于非糖尿病者.住院期间以及2年累计的死亡、慢性心力衰竭以及心肌梗死、卒中、心力衰竭和死亡的联合终点事件发生率均明显高于非糖尿病者.多因素回归分析显示,年龄≥70岁、糖尿病、既往心肌梗死、既往心力衰竭、就诊时收缩压<90 mm Hg(1 mm Hg=0.133 kPa)和心率>100次/min是非ST段抬高ACS患者2年死亡的危险因素.结论 合并糖尿病的非ST段抬高ACS患者住院期间和2年死亡、慢性心力衰竭和联合终点事件发牛率明显高于非糖尿病者.糖尿病是非ST段抬高ACS患者2年死亡的独立危险因素.我国非ST段抬高ACS患者住院期间抗血小板治疗和早期介入检杳和治疗有待加强.有必要进行更有针对性的大规模临床研究,以提高糖尿病并发ACS的治疗水平,改善该人群的预后.

Abstract：

Objective To observe the clinical characteristics,treatment options and outcome of diabetic patients with non-ST elevation acute coronary syndromes(NSTEACS).Methods Consecutive patients admitted with NSTEACS from 38 centers in north China were enrolled.Medical histories,clinical characteristics,treatments and outcomes were evaluated and follow-up was made at 6,12,and 24 months 'after their initial hospital admission.Cumulative event rates were compared between diabetic and nondiabetic patients.Results There were 420 diabetic patients out of 2294 NSTEACS patients(18.3%).Diabetic patients were older[(64.9±6.7)years vs.(62.3±8.6)years,P<0.01],more often women (48.1% vs.35.3%,P<0.05)and were associated with higher baseline comorbidities such as previous hypertension,myocardial infarction,congestive heart failure and stroke than non-diabetic patients.The incidence of antiplatelet therapy(92.1% vs.95.O%,P<0.05),coronary angiography(30.0% vs.36.3%,P<0.05)and revascularization(12.1% vs.18.8%,P<0.05)was lower in patients with diabetes than non-diabetic patients.In hospital and 2-year mortality as well as the incidence of congestive heart failure and composite outcomes of myocardial infarction,stroke,congestive heart failure and death were substantially higher in diabetic patients compared with non-diabetic patients.Muhivariative Cox regression analysis revealed that age≥70 years,diabetes,previous myocardial infarction,previous congestive heart failure,systolic blood pressure less than 90 mm Hg(1 mm Hg=0.133 kPa)and heart rate more than 100bpm at admission were risk factors for 2-year death.Conclusion In NSTEACS,diabetes is associated with higher rate of in-hospital and 2-year death,congestive heart failure and composite outcomes of myocardial infarction,stroke,congestive heart failure and death.Diabetes mellitus is a major independent predictor of 2-year mortaliy post NSTEACS.Status of antiplatelet therapy,coronary angiography and revascularization should be improved for diabetic patients with NSTEACS during hospitalization.     

Diabetic Cardiomyopathy in the Elderly

Diabetic cardiomyopathy is a microvascular disorder that occurs in diabetics that may lead to congestive heart failure (CHF) in the absence of hypertension, coronary artery disease, or valvular heart disease. In a large study of elderly subjects with 865 men and 1872 women, mean age 81?±?9 years, CHF developed in 272 of 690 diabetics (39 %) and in 467 of 2047 nondiabetics (23 %) (P?<?0.0001) at 43-month follow-up. Cox regression analysis showed that diabetes mellitus (risk ratio = 1.34, P?=?0.0003) was an independent significant predictor of time to development of CHF. For each 1 % increase in hemoglobin A1c, in 25,958 men and 22,900 women with diabetes, there was an 8 % increased risk of CHF (95 % CI, 5 %–12 %). The pathologic substrate of diabetic cardiomyopathy is characterized by myocardial damage, left ventricular hypertrophy, interstitial fibrosis, structural and functional changes of the coronary vessels, metabolic abnormalities, and autonomic cardiac neuropathy.     

Coronary heart disease risk factors ranked by importance for the individual and community. A 21 year follow-up of 12 000 men and women from The Copenhagen City Heart Study.

AIMS: The importance of coronary heart disease risk factors may differ between individuals and community and by sex and age. METHODS AND RESULTS The Copenhagen City Heart Study followed for 21 years a random sample of 5599 men and 6478 women aged 30 to 79 years at baseline. The importance of risk factors in individuals and the community were evaluated as relative- and population-attributable risks. We traced 2180 coronary events. In Cox regression analysis with ten risk factors entered simultaneously, relative risks for coronary heart disease in men ranged from 1.69 to 1.20 with the highest risks for diabetes, hypertension, smoking, and physical inactivity. In women, relative risks ranged from 2.74 to 1.19 with the highest risks for diabetes, smoking, hypertension, and physical inactivity. Population-attributable risks in men ranged from 22% to 3% with the highest risks for smoking, hypertension, and no daily alcohol intake. In women, attributable risks ranged from 37% to 3% with the highest risks for smoking, hypertension, and hypercholesterolaemia. Several of these rankings differed by age. CONCLUSIONS: The importance of coronary heart disease risk factors may differ for individuals, the community, and by sex and age. Consequently, prevention strategies should be tailored accordingly.     

Coronary artery disease in young women and men with long-standing insulin-dependent diabetes

The prevalence and predictors of coronary artery disease were examined in people aged 40 years and younger with insulin-dependent diabetes mellitus. Analysis was performed on those who presented between 1999 and 2003 for kidney and/or pancreas transplant at the University of Minnesota, as all patients who have diabetes mellitus are required to have perioperative cardiology evaluation. The mean age was 33.5 +/- 4.4 years for 88 subjects, all had insulin-dependent diabetes mellitus, and 33% were dialysis dependent. Severe coronary artery disease was found in 18.2% of women and in 24.2% of men. Three-vessel coronary artery disease trended less in women (9.1%) compared with men (12.1%). Multivariate predictors for severe and 3-vessel coronary artery disease included prior coronary artery disease, hypertension duration, and ST-T wave changes on electrocardiogram. Coronary artery disease is twice as high as expected in young woman. Studies on early management for atherosclerosis are warranted in this high-risk population.     

Mortality of diabetic patients in Warsaw--22 year prospective observation (1973/74-1995). I. Mortality of diabetic patients with type 2 diabetes (non-insulin-dependent-diabetes)

In the period 1973/74-1995 a prospective observation was carried out on 4420 diabetic patients (1990 males and 2430 females) aged 30-68 years, with type 2 (non-insulin dependent diabetes) of 1-10 years duration. During the 22-years period nearly 80% of initial cohort died. The risk of death were 2-times higher in diabetes than in the samples of general population observed at the same time. The death risk from cardiovascular disease were over 3-times higher than in general population. The relevant risk ratio has been found over 5-times higher for coronary heart disease, which were unlike to results from the differences in death ascertainment between diabetics and the city dwellers. The all-causes ratio of death and cardiovascular diseases were the same for women and men but it was selectively higher for females then males group for coronary heart disease and cerebrovascular diseases. Among diabetic cohort the risk of death was also higher for neoplasms, especially in women.     

Major and minor electrocardiographic abnormalities and risk of death from coronary heart disease, cardiovascular diseases and all causes in men and women

The independent contributions of baseline major and minor electrocardiographic (ECG) abnormalities to subsequent 11.5 year risk of death from coronary heart disease, all cardiovascular diseases and all causes were explored among 9,643 white men and 7,990 white women aged 40 to 64 years without definite prior coronary heart disease in the Chicago Heart Association Detection Project in Industry. At baseline, prevalence rates of major ECG abnormalities were higher in women than in men, with age-adjusted rates of 12.9 and 9.6% (p less than 0.01), respectively. Minor ECG abnormalities were more common in men than in women (7.3 versus 4.5%, p less than 0.01). Both major and minor ECG abnormalities were associated with an increased risk of death from coronary heart disease, all cardiovascular diseases and all causes. The strength of these associations was greater in men than in women. When baseline age, diastolic pressure, serum cholesterol, cigarettes smoked per day, diabetes and use of antihypertensive medication were taken into account, major abnormalities continued to be significantly related to each cause of death in both genders with much larger adjusted absolute excess risk and relative risk for men than for women. In multivariate analyses, minor ECG abnormalities contributed independently to risk of death in men, but not clearly so in women. The results indicate the independent association between ECG abnormalities and mortality from coronary heart disease, all cardiovascular diseases and all causes, with greater relative significance in middle-aged United States men than women.     

Cardiovascular risk and validation of cardiovascular risk prediction functions in a cohort of patients with type 2 diabetes followed for 10 years in Badajoz (SPAIN). AN observational study

AimsTo analyse whether diabetes behaves as an equivalent of coronary risk and assess the performance of the original and REGICOR Framingham functions in a cohort of patients with type 2 diabetes observed for 10 years in primary care practices in Badajoz, Spain.MethodsObservational, longitudinal study. A total of 643 patients (mean age 64.0 years, 55.7% women), without evidence of cardiovascular disease were studied. We assessed the incidence of cardiovascular events and the patients’ 10-year coronary risk predicted-values at the time of their recruitment.ResultThe actual incidence rate of coronary events was 14.5% (15.1% in women and 13.7% in men, p = 0.616). Patients who suffered coronary events were older (66.3 vs 63.6 years, p < 0.05), had higher total cholesterol (236.3 vs 219.5 mg/dl, p < 0.01), fasting plasma glucose levels (177.6 vs 159.8 mg/dl, p < 0.01), glycated haemoglobin (7.3 vs 6.7%, p < 0.05) and also higher prevalence of high blood pressure, dyslipidemia and chronic renal disease. The original Framingham equation overpredicted risk by 88%, whereas the REGICOR Framingham function underpredicted risk by 24%.ConclusionsDiabetes in our cohort does not behave as a coronary heart disease equivalent and both the original and REGICOR Framingham coronary risk functions have little utility in a diabetic population.