The diabetes-cardiovascular risk paradox: results from a Finnish population-based prospective study

Aims To assess changes in coronary heart disease (CHD) event rates and CHD mortality rates among diabetic and non-diabetic individuals between two large study cohorts with baseline assessments 10 years apart and followed up for 10 years. Methods and results Four population surveys were carried out in 1972, 1977, 1982, and 1987 in a randomly selected independent population in Finland. For the analyses, we combined the 1972 and 1977 cohorts (cohort 1) and similarly also the 1982 and 1987 cohorts (cohort 2). A total of 16 779 men and 18 235 women were followed up for 10 years. Whereas the risk of first cardiovascular disease event in women did not change between the two cohorts, the risk in diabetic men aged 25-49 years and men of all age groups with incidence diabetes during the follow-up decreased compared with the earlier cohort. The relative risk of CHD mortality in men with baseline diabetes or incident diabetes compared with non-diabetic individuals increased (from 1.67 to 1.75 and 1.00 to 1.92, respectively). CHD event rates and CHD mortality rates decreased among non-diabetic individuals between the two study cohorts. Conclusion Special attention should be given to prevent the onset of diabetes in the population and to intensify the management of patients with diabetes.