HYPERGLYCEMIA AND COMPOSITIONAL LIPOPROTEIN ABNORMALITIES AS PREDICTORS OF CARDIOVASCULAR MORTALITY IN TYPE-2 DIABETES - A 15-YEAR FOLLOW-UP FROM THE TIME OF DIAGNOSIS

OBJECTIVE - We studied the 15-year cardiovascular mortality and morbid ity of newly diagnosed patients with type 2 diabetes and of nondiabeti c control subjects and the predictors of cardiovascular mortality in d iabetic patients. RESEARCH DESIGN AND METHODS - We performed a 15-year prospective study of 133 middle-aged patients with newly diagnosed ty pe 2 diabetes and 144 control subjects. Cardiovascular risk factors we re assessed in both groups at baseline and after 5 and 10 years. RESUL TS - Total mortality was markedly higher in patients with type 2 diabe tes (total: 44.3 vs. 12.9% for men, age-adjusted odds ratio [OR] 5.0, P < 0.001; 44.4 vs. 11.0% for women, OR 5.2, P < 0.001), which was due to increased cardiovascular mortality (ORs for men and women: 6.2 and 11.2, respectively P < 0.001 for both). The incidences of fatal and n onfatal myocardial infarction and stroke were likewise higher in diabe tic patients. In univariate analyses and various multiple logistic reg ression analyses, hyperglycemia was a constant predictor of cardiovasc ular mortality assessed at the time of diagnosis or at 5- or 10-year e xaminations. Moreover, lipoprotein abnormalities characteristic of typ e 2 diabetes (low HDL cholesterol, high LDL triglycerides or apolipopr otein B levels, and low LDL cholesterol/apolipoprotein B ratio as a ma rker for LDL size) were predictive of cardiovascular death in these an alyses. CONCLUSIONS - This long-term study of a well-characterized gro up of newly diagnosed patients strengthens the view that the prognosis in middle-aged subjects is markedly impaired and that both hyperglyce mia and compositional lipoprotein abnormalities are predictors of card iovascular mortality in patients with type 2 diabetes.