Based on the observations from several epidemiologic studies, diabetes is designated a coronary heart disease (CHD)-risk equivalent by the National Cholesterol Education Program's Adult Treatment Panel III (ATPIII) . The 10-year risk of major CHD events in patients who have diabetes is greater than 20%; this is comparable to the rates that are observed in nondiabetic patients who have established CHD. This inference has been borne out, particularly by data from a population study in Finland  and a multi-national study, the Organization to Assess Strategies for Ischemic Syndromes , of patients who had type 2 diabetes who frequently had multiple, coexisting risk factors for cardiovascular disease (CVD). The increased risk for CHD may precede the clinical diagnosis of diabetes by many years. This was documented best in the long-term study of more than 117,000 women in the Nurses' Health Study; nearly 6000 women developed diabetes during 20 years of follow-up. There was an approximately twofold to threefold increased risk for myocardial infarction (MI) or stroke during the "prediabetes" period, compared with women who remained nondiabetic . In another study, Multiple Risk Factor Intervention Trial, in a large number of men (348,000, of which 5163 had diabetes), the presence of diabetes was associated with a threefold to fourfold increased risk for age-adjusted
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cardiovascular mortality at comparable levels of cholesterol, blood pressure, and cigarette smoking . This suggests an enhanced susceptibility of diabetic vasculature to the well-established risk factors for CHD.
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