Evidence:

• Persons with asymptomatic prediabetic states of impaired glucose tolerance and impaired fasting glucose have an increased risk of CVD and death compared to those with normal glucose levels (7; 27; 28; 29; 30; 31; 32; 33; 34; 35; 36).
• Based on Framingham data, the risk of cardiovascular events in patients with diabetes is two to three times greater than in those without diabetes, and their absolute risk crosses the 10% threshold by age 55 in men and age 60 in women (37; 38).
• More recent data from a 45- to 64-year-old Finnish cohort suggest that the risk of MI in diabetes patients with no history of previous MI is comparable to the risk of nondiabetes patients who have had a previous MI (19% vs. 20% 7-year absolute risk, respectively) (39). The 7-year risk of recurrent MI in persons with diabetes and CVD is 45%, compared with 20% in those with CVD but no diabetes (39).
• Another study of Scotland residents, aged 45 to 64 years, compared the 8-year risk of MI between diabetes patients without CVD and nondiabetes patients who had had an MI within the previous 8 years. The risk of MI was higher in the patients with a recent MI than those with diabetes, which contradicts the Finnish study. One explanation is that the Finnish study excluded patients with diet-controlled diabetes, resulting in a population with more advanced disease than in the Scottish study. However, the diabetes patients still had an almost 10% absolute risk of a first MI within 8 years, a risk cutpoint considered worthy of primary intervention (40).
• The benefits of screening for type 2 diabetes depend largely on baseline CVD risk, and the benefits may be greatest in patients with a baseline 10-year CVD risk of >8% (41).

Comments:

• None.