Cardiovascular complications in Type 2 diabetes mellitus depend on the coronary angiographic state rather than on the diabetic state

Excerpt

To the Editor: Cardiovascular disease is the major complication from Type 2 diabetes mellitus. In a landmark study [1], the risk for myocardial infarction has been reported as high for diabetic patients without prior myocardial infarction compared with non-diabetic patients with prior myocardial infarction. From these data, it has been generalized that Type 2 diabetes bears a risk equal to pre-existing coronary artery disease (CAD) and numerous guidelines have been based on this risk equivalent worldwide. However, other data have challenged the concept, pointing to a lower cardiovascular risk in diabetic patients than in patients already affected by CAD [2, 3]. An important limitation of epidemiologic studies is that the state of the coronary arteries at baseline is not known. Because CAD often is present, albeit silent in diabetic patients, the diabetic state often represents a state of evolving coronary atherosclerosis. We hypothesized that the risk for future cardiovascular events in diabetic patients depends on the state of the coronary arteries at baseline rather than on the diabetic state per se. …