Normal Risk for Diabetics with No Obstructive CAD

A recent study in Cardiovascular Diabetology suggests that diabetics with no obstructive coronary artery disease (CAD) have a similar 10-year heart attack risk to the general population. The study included 5,734 diabetes patients from Western Denmark with no obstructive CAD, and 28,670 matched individuals from the general population. All patients without obstructive CAD were examined via coronary angiography. The primary outcomes of interest were myocardial infarction (MI), ischemic stroke, and death. Researchers computed the 10-year cumulative incidences of each of the study’s endpoints. Median follow-up was seven years. According to the results, diabetic patients without obstructive CAD had a similar 10-year risk of MI to that of the general population (3.2% vs. 2.9%, respectively; adjusted HR=0.93; 95% CI, 0.72 to 1.20). Those patients, however, had higher risk for ischemic stroke (5.2% vs 2.2%, respectively; adjusted HR=1.87; 95% CI, 1.47 to 2.38) and also for mortality (29.6% vs 17.8%, respectively; adjusted HR=1.24; 95% CI, 1.13 to 1.36) compared to the general population. “Medical treatment of diabetes, especially with insulin, and long duration of diabetes may exacerbate the risk of ischemic stroke and death compared to that experienced by a general population cohort,” the authors wrote. “Despite absence of obstructive CAD and a low risk of MI, diabetes still remains associated with other cardiovascular outcomes.” The authors cautioned that the study results may not necessarily be applicable to all patients with diabetes, or the general population. “Our observational study provides data on the cardiovascular risk in Danish patients with diabetes compared to the Danish general population,” they wrote. “The results, however, may not be representative for patients with diabetes or general population individuals in other countries with different health care systems and ethnicities.