During the 10 years’ follow up of the 5934 men, 1357 died of all causes including 637 CVD deaths (47% of all causes) and 417 CHD deaths; there were 662 major CHD events and 305 major stroke events. Table 1 presents the characteristics at Q92 for the five groups. Men with CHD were generally older than those with diabetes. Diabetic men, with or without CHD, had the highest obesity rates but the prevalence of overweight (26–29.9 kg/m2) did not vary significantly between the five groups. Diabetic men without CHD had higher hypertension rates than non-diabetic men with no CHD, but the prevalence of CVD symptoms (chest pain, severe chest pain, and breathlessness) was only slightly increased. The prevalence of CVD symptoms was very high among men with CHD (with or without diabetes). Men with diabetes and CHD tended to have the worst risk factor profile.
Table 1 Characteristics obtained from the 1992 questionnaire according to diabetes and coronary heart disease (CHD) status of 5934 British men aged 52–74 years
The cumulative event rate among diabetic men without CHD (19.0%) was similar to the rate among men with a doctor diagnosis of angina only (19.9%). Men with diagnosed MI had a 29% event rate and this increased to 50.2% among men with both diabetes and CHD compared with 8.6% in men with no diabetes or CHD. Figure 1 shows the Kaplan-Meier estimates of the probability of survival for CHD, CVD, and all cause mortality stratified by history of diabetes and CHD. Men with both diabetes and CHD had by far the worst prognosis. These men had a less than 50% survival probability for CVD death compared with 71% for those with MI, 82% for men with angina only, 81% for men with diabetes only, and 92% for men with no diabetes or CHD. Considering all cause mortality, only a third of the men with diabetes and CHD were alive after 10 years.
Figure 1 Kaplan-Meier estimates of probability of survival (%) for (A) coronary heart disease (CHD), (B) cardiovascular disease (CVD), and (C) all (more ...)
Table 2 shows the rates/1000 person-years and adjusted relative risks for major CHD events, CHD deaths, major stroke events, and deaths from CVD and all causes for the five groups. The diabetes only group had significantly higher adjusted risk of major CHD events, CHD deaths, stroke events, and CVD death than non-diabetic men with no CHD, and the adjusted relative risks were higher than for those with angina only. Men with MI had a higher risk of cardiovascular outcomes (with the exception of stroke) than diabetic men without CHD, but risk was by far the highest in men with diabetes and CHD. These men had nearly a ninefold increase in risk of CHD death compared with non-diabetic men with no CHD, whereas this was nearly three- to fourfold in men with diabetes or CHD. Although those with diabetes only were less likely to have a major CHD event than men with prior MI, their case fatality was similar to that in men with prior MI. Men with diabetes and CHD were very unlikely to survive a subsequent MI, with case fatality rates of nearly 90%. Total mortality was similar in the diabetes and the CHD groups but was by far the highest among men with both conditions. In men with a history of diabetes or CHD (angina or MI) over half of all deaths were due to CVD causes, and in men with diabetes and CHD the vast majority died of CVD causes (78%). Overall, men with diabetes only had CHD and CVD mortality and total mortality outcomes intermediate between non-diabetic men with angina and men with prior MI.
Table 2 Rates/1000 person-years (p-y) and adjusted relative risk (RR) for major CHD and stroke events and CHD deaths, and for CVD deaths and all cause mortality according to doctor diagnosed diabetes and prior CHD status (more ...)
We also directly compared the risk of the major outcomes between men with CHD and men with diabetes (table 3). Men with angina only had slightly lower (non-significant) risk of CHD and CVD outcome than men with diabetes only. Men with prior MI had significantly higher risk of CHD events than men with diabetes without CHD and higher risk of CHD and CVD deaths, but the numbers were small and the differences were of marginal significance (p
0.08 and p
0.06, respectively). Diabetes with CHD increased the risk threefold for CHD events and deaths and CVD deaths compared with diabetes without CHD.
Table 3 Adjusted RR of major CHD and stroke events, CHD, CVD deaths and total mortality compared with diabetic men
We also examined the risk of major CVD outcomes by duration of diabetes among men with diabetes without CHD (table 4). Risk of CHD events, CHD deaths, and CVD deaths increased with increasing duration of diabetes. Risk among men with diabetes diagnosed > 12 years before screening approached the risk among men with MI (table 2).
Table 4 Duration of diabetes and adjusted RR of major CHD events and death from CHD, CVD, and all causes in men with no diagnosis of CHD