Predictors of macrovascular disease in patients with type 2 diabetes mellitus

Objective: To assess the importance of classic and nonclassic risk factors in the development of coronary artery disease (CAD) or cerebrovascular dise ase (CVD) in patients with type 2 diabetes mellitus (DM). Patients and Methods: In this community-based, prospective cohort study, qu antitative measurements for cholesterol, triglycerides (TGs), glucose, and lipoprotein(a) detected as a sinking pre-beta -lipoprotein band on electrop horesis were obtained from 1968 through 1982 from 349 patients who were fre e of CAD and CVD but had type 2 DM, Demographic data and covariables obtain ed were age, body mass index, duration of diabetes, sex, smoking, and hyper tension. The relationship of individual continuous factors to the developme nt of CAD and CVD as well as multivariate models were evaluated with use of the Cox proportional hazards model. The primary outcome was to determine w hich risk factors are associated with development of CAD or CVD in patients with type 2 DM. Results: After a mean follow-up of 13 years, 216 CAD and 115 CVD events had developed. The hazard ratio estimates with 95% confidence intervals (CIs) for CAD after multivariate analysis were significant for age, 1.45 (95% CI, 1.27-1.67); fasting glucose levels at enrollment, 1.63 (95% CI, 1.17-2.25) ; smoking, 1.45 (95% CI, 1.10-.91); and TGs, 1.49 (95% CI, 1.5-192), The ha zard ratio estimates for CVD were significant for age, 1.95 (95% CI, 1.59-2 .38); hypertension, 1.89 (95% CI, 1.30-2.74); fasting glucose levels at enr ollment, 1.69 (95% CI, 1.06-2.70); and smoking, 1.57 (95% CI, 1.07-2.30). Conclusion: In diabetic patients, age, fasting glucose levels, smoking, and TG levels are independent risk factors for development of CAD events. Age, hypertension, glucose, and smoking predicted development of CVD events.