INTERNATIONAL VARIATIONS IN CARDIOVASCULAR MORTALITY ASSOCIATED WITH DIABETES-MELLITUS - THE WHO MULTINATIONAL STUDY OF VASCULAR-DISEASE INDIABETES

The WHO Multinational Study of Vascular Disease in Diabetes was launch ed in 1975-77 to investigate international variations in the occurrenc e of different manifestations of vascular disease in subjects with ins ulin-dependent and non-insulin-dependent diabetes. A morbidity and mor tality follow-up extending until January 1, 1988 was carried out in 10 centres, including five European centres (London, Switzerland, Berlin , Warsaw and Zagreb), two East Asian centres (Hong Kong and Tokyo), tw o Native American centres (Arizona and Oklahoma) and one Caribbean cen tre (Havana). Of a total of 4714 diabetic subjects (2310 men and 2404 women) aged between 35 and 55 years at baseline who were successfully followed up, 1266 were classified as having insulin-dependent diabetes and 3448 as having non-insulin-dependent diabetes. There was a large variation between the centres in ischaemic heart disease and cerebrova scular disease mortality rates for both insulin-dependent and non-insu lin-dependent diabetic subjects, presumably reflecting in part differe nces between the background populations in mortality rates from these cardiovascular causes. The lowest ischaemic heart disease mortality ra tes for diabetic subjects were observed in Hong Kong and Tokyo centres , representing industrialized countries which have continued to have l ow ischaemic heart disease mortality rates. The importance of raised b lood pressure and proteinuria as potentially modifiable cardiovascular risk factors in diabetic subjects was confirmed in this study.