Article Summary The Independent Effect of Type 2 Diabetes Mellitus on Ischemic Heart Disease, Stroke, and Death. A Population-Based Study of 13,000 Men and Women With 20 Years of Follow-up. Almdal T, Scharling H, Jensen JS, Vestergaard H. Arch Intern Med. 2004;164:1422-1426. Objective: To estimate the effect of cardiovascular disease morbidity and mortality in patients with type 2 diabetes. Methods: All patients admitted to hospitals in Denmark are reported to a national hospital registry, which makes it possible to examine admission for various diseases. The Copenhagen City Heart Study is a prospective, population-based study conducted from 1976 through 1997. This present study is based on 13,105 people (7198 women, 5907 men) for whom specific variables were available. Participants were classified as nondiabetic (control) group, intermediate (nondiabetic with nonfasting plasma glucose levels in the 120 mg/dL to 200 mg/dL range), and the type 2 diabetes group (patients who were currently being treated either with diet or diet and oral hyperglycemic agents or who had a nonfasting plasma glucose level over 200 mg/dL). All subjects were followed through 1997 for hospital admission for nonfatal or fatal ischemic heart disease, acute myocardial infarction (AMI), stroke, or death from all causes. The Cox proportional hazards model was used to calculate relative risks. Results: Total mortality among women was 1.7 to 2.7 times higher in patients with type 2 diabetes compared to controls. In the subgroup of women under 55 years of age, 10% were admitted for AMI, and 13% for stroke. In the subgroup of women over 55 years of age, hospitalizations were 35% and 43% respectively, for the same conditions. Total mortality among men was 2.5% higher in those with type 2 diabetes compared to controls in the under-55 subgroup. The number of men admitted for MI or stroke in the younger subset was 2.7 to 3.2 times higher than controls, with 24% of patients with type 2 diabetes admitted because of AMI and 20% because of stroke. Conclusion: In this population-based prospective study, patients with type 2 diabetes were at increased risk of MI and stroke, independent of other risk factors suggesting that all patients with type 2 diabetes should be evaluated for the risk of vascular disease.