Diabetes as a coronary artery disease risk equivalent: before a change of paradigm?

BackgroundCurrent guidelines consider diabetes per se as a coronary artery disease (CAD) risk equivalent. We aimed at investigating the contribution of baseline coronary atherosclerosis to the risk of diabetic patients for future vascular events. Design Prospective cohort study.MethodsVascular events were recorded over 4 years in 750 consecutive patients undergoing coronary angiography for the evaluation of stable CAD.ResultsFrom our patients, 244 had neither type 2 diabetes (T2DM) nor significant CAD (i.e. coronary stenoses ≥ 50%) at the baseline angiography, 50 had T2DM but not significant CAD, 342 did not have T2DM but had significant CAD, and 114 had both T2DM and significant CAD. Nondiabetic patients without significant CAD had an event rate of 9.0%. The event rate was similar in T2DM patients without significant CAD (8.0%, P = 0.951), but higher in nondiabetic patients with significant CAD (24.9%, P < 0.001). Patients with T2DM and significant CAD had the highest event rate (43.0%). Importantly, T2D...