Life and death in Denmark: lessons about diabetes and coronary heart disease.

The prevalence of diabetes mellitus, primarily type 2 diabetes mellitus, is increasing at epidemic rates in the United States and worldwide, driven largely by increasing rates of obesity and advancing age for populations living in westernized countries. Diabetes mellitus is associated with a 2to 4-fold increase in the risk of coronary heart disease, and among people with diabetes, about two thirds of deaths are due to cardiovascular disease, including ischemic heart disease, congestive heart failure, and stroke.1 The increase in mortality for patients with diabetes mellitus after myocardial infarction is seen both acutely and in a sustained manner and holds true for both men and women. Indeed, many have suggested diabetes mellitus to be a coronary heart disease risk equivalent, because multiple studies have demonstrated that patients with diabetes but without prior cardiovascular disease have the same event rates as individuals without diabetes but with prior cardiovascular disease.2,3 However, this suggestion has remained somewhat controversial, especially for patients at younger ages.2,4,5