Published Online
on December 1, 2003

A more recent version of this article appeared on December 1, 2003

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Submitted on August 8, 2003
Accepted on August 26, 2003

Is Diabetes Mellitus a Cardiovascular Disease Risk Equivalent for Fatal Stroke in Women? Data From the Women’s Pooling Project

Jennifer E. Ho MD; Furcy Paultre PhD; and Lori Mosca MD, PhD^*

From Harvard Medical School, Boston, Mass (J.E.H.), and Columbia University, New York, NY (F.P., L.M.)

^* To whom correspondence should be addressed. E-mail: ljm10{at}columbia.edu.

Background and Purpose--Diabetes mellitus is an independent risk factor for stroke and is associated with a 1.8- to 6-fold increased risk compared with nondiabetic subjects. Recent guidelines have classified diabetes as a coronary heart disease risk equivalent. Whether diabetes is a cardiovascular disease risk equivalent for stroke is not established.

Methods--Data were pooled from 9 prospective epidemiological studies in the United States. We followed up 27 269 women (8.5% diabetic, 2.9% with prior myocardial infarction, 2.3% with prior stroke) for an average of 8.3 years, during which 238 stroke deaths were observed.

Results--Both diabetic subjects without cardiovascular disease and nondiabetic subjects with history of prior stroke had a significantly increased risk of 10-year stroke mortality compared with nondiabetic subjects without prior cardiovascular disease (hazard ratio [HR], 6.77; 95% confidence interval [CI], 4.56 to 10.05; HR, 3.37; 95% CI, 2.38 to 4.77). History of prior myocardial infarction was not associated with long-term stroke mortality (HR, 0.66; 95% CI, 0.27 to 1.61). After adjustment for risk factors, diabetic subjects had similar risk compared with subjects with a history of prior stroke (HR, 1.29; P=0.43).

Conclusions--Diabetic subjects without cardiovascular disease have a fatal stroke risk similar to that of nondiabetic subjects with a history of prior stroke and similar risk factor profile. This suggests that diabetes mellitus may be classified as a stroke risk equivalent and may warrant more aggressive treatment strategies in the future prevention of stroke.

Key words: cardiovascular diseases • diabetes mellitus • epidemiology • stroke • women

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