Lancet Reg Health Eur. 2026 Jun 19;67:101753. doi: 10.1016/j.lanepe.2026.101753. eCollection 2026 Aug.
ABSTRACT
BACKGROUND: In the pre-statin era, diabetes posed a similar cardiovascular risk as previous myocardial infarction in patients without diabetes. Since the development of statins, several primary preventive treatment strategies have been introduced. We investigated whether diabetes and coronary heart disease (CHD) confer similarly high cardiovascular risk in a semi-nationwide contemporary cohort.
METHODS: We included all individuals aged 50-89 residing in Western Denmark on January 1, 2012. Participants were categorized into four groups: diabetes alone, CHD alone, both diabetes and CHD, and neither condition. CHD was defined as previous myocardial infarction, coronary revascularization, or documented coronary artery disease. Participants were followed for up to seven years for major adverse cardiovascular events (MACE), coronary events (myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting), non-coronary vascular events (ischemic stroke, lower limb revascularization, or amputation), and all-cause mortality.
FINDINGS: We included 1,116,456 people residing in Western Denmark on January 1, 2012. Of these, 7.5% (84,186/1,116,456) had diabetes alone; 5.0% (55,072/1,116,456) had CHD alone. Diabetes alone, compared with CHD alone, was associated with lower seven-year rates of MACE (10.8% versus 19.7%, adjusted hazard ratio (HR) 0.77, 95% CI 0.74-0.78) and coronary events (6.1% versus 16.0%, adjusted HR 0.46, 95% CI 0.44-0.48), but higher rates of non-coronary vascular events (9.4% versus 9.9%, adjusted HR 1.27, 95% CI 1.22-1.32) and all-cause mortality (25.6% versus 30.6%, adjusted HR 1.31, 95% CI 1.28-1.33).
INTERPRETATION: Diabetes alone does not carry the same coronary or cardiovascular risk as CHD alone, but it is associated with increased rates of non-coronary vascular events and all-cause mortality.
FUNDING: This study was funded by the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
PMID:42371531 | PMC:PMC13310599 | DOI:10.1016/j.lanepe.2026.101753