Article 3

Division of Endocrinology and Metabolism Department of Medicine Loyola University Chicago Maywood, Illinois and Research and Medical Services VA Hospital Hines, Illinois betes experienced a smaller decline in heart disease mortality in the period between 1982 to 1984 versus the period between 1971 to 1975 compared with nondiabetic individuals in the same periods.11 A recent analysis of middle-aged Finnish men and women found that subjects who had diabetes but were free of cardiovascular disease had the same risk level of CHD mortality as those subjects with a history of MI but without diabetes.12 The US Physicians Health Study (USPHS) was a randomized, double blind, placebo-controlled trial of 91,285 US male physicians (82,247 men free of both DM and CHD, 2,317 men with DM but not CHD, 5,906 men with CHD but no DM and 815 men with both DM and CHD), aged 40 to 84 years followed over 5 years with regard to all cause and CHD mortality13. Compared to men without diabetes or CHD, the age-adjusted relative risk of death from any cause was 2.3 (95% CI, 2.0–2.6) among men with DM only, 2.2 (95% CI, 2.0–2.4) among men with CHD only, and 4.7 (95% CI, 4.0–5.4) among men with both DM and CHD. The relative risk of CHD mortality was 3.3 (95% CI, 2.6–4.1) among men with DM only, 5.6 (95% CI, 4.9–6.3) among men with CHD only, and 12.0 (95% CI, 9.9–14.6) among men with Clinical Trial Evidence for Cardiovascular Risk Reduction in Type 2 Diabetes