Diabetes and all-cause and coronary heart disease mortality among US male physicians

Background: While diabetes has long been associated with increased risk of coronary heart disease (CHD), the magnitude of risk of diabetes-related CHD is uncertain. Objective: To evaluate the impact of diabetes and prior CHD on all-cause an d CHD mortality. Methods: In a prospective cohort study of 91 285 US male physicians aged 40 to 84 years, participants were divided into 4 groups. (1) a reference grou p of 82 247 men free of both diabetes and CHD (previous myocardial infarcti on and/or angina) at baseline, (2) 2317 men with a history of diabetes but not CHD, (3) 5906 men with a history of CHD but not diabetes, and (4) 815 m en with a history of both diabetes and CHD. Rates of all-cause and CHD mort ality were compared in these groups. Results: Over 5 years (49 7952 person-years of followup), 3627 deaths from all causes were documented, including 1242 deaths from CHD. Compared with m en with no diabetes or CHD, the age-adjusted relative risk of death from an y cause was 2.3 (95% confidence interval [CI], 2.0-2.6) among men with diab etes and without CHD, 2.2 (95% CI, 2.0-2.4) among men with CHD and without diabetes, and 4.7 (95% CI, 4.0-5.4) among men with both diabetes and CHD. T he relative risk of CHD death was 3.3 (95% CI, 2.6-4.1) among men with diab etes and without CHD, 5.6 (95% CI, 4.9-6.3) among men with CHD and without diabetes, and 12.0 (95% CI, 9.9-14.6) among men with both diabetes and CHD. Multivariate adjustment for body mass index, smoking status, alcohol intak e, and physical activity as well as stratification by these variables did n ot materially alter these associations. Conclusions: These prospective data indicate that diabetes is associated wi th a substantial increase in all-cause and CHD mortality. For all-cause mor tality, the magnitude of excess risk conferred by diabetes is similar to th at conferred by a history of CHD; for mortality from CHD, a history of CHD is a more potent predictor of death. The presence of both diabetes and CHD, however, identifies a particularly high-risk group.