NEW YORK (Reuters Health) - Although people with diabetes are known to be at higher risk for heart problems, new study findings suggest that diabetics in their 40s, 50s or 60s who are otherwise healthy fare better than people without diabetes who have had a heart attack in the past.

Previous research has identified diabetics as being at high risk of developing heart disease. Indeed, some experts have gone so far as to suggest that patients with type 2 diabetes should be treated as if they already have heart disease--regardless of their medical history.

Now, reporting in the April 20th issue of the British Medical Journal, Dr. Josie M. M. Evans of Ninewells Hospital in Dundee, Scotland, and colleagues are offering a different perspective.

In a head-to-head comparison of nearly 5,000 patients diagnosed with type 2 diabetes and nearly 9,000 patients who had a previous heart attack, the diabetes patients were found to be at lower risk of cardiovascular complications and death than those who had had heart attacks, the investigators found.

In the study, Evans and colleagues monitored the health status of two groups of patients. The first group contained 1,155 patients with type 2 diabetes and 1,347 patients who had had a heart attack. The health status of these patients was monitored for 8 to 15 years.

In the second group, 3,477 patients with type 2 diabetes were compared with 7,414 patients who had a previous heart attack. The health status of this group was monitored for 8 years. All of the patients in the study were between 45 and 64 years old.

During the follow-up period, patients in group 1 that had had a heart attack were more than two times more likely to die from any cause compared with the diabetics, the report indicates.

Heart attack patients in group 2 were 1.35 times more likely to die from all causes, 2.93 times more likely to die of a heart attack and 3.10 times more likely to be hospitalized as a result of another heart attack than the patients with diabetes, according to the report.

"Our results do not support the hypothesis that patients with diabetes have as high a cardiovascular risk as patients with established coronary heart disease," Evans and colleagues write.

The findings suggest that physicians should treat type 2 diabetes patients on a case-by-case basis, based on their individual risk factors for heart disease, and should not necessarily treat all such patients as if they already have heart disease, the authors conclude.

SOURCE: British Medical Journal 2002;324:939-942.

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