Article Summary Type 2 diabetes as a "coronary heart disease equivalent": an 18-year prospective population-based study in Finnish subjects. Juutilainen A, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Diabetes Care. 2005;28:2901-2907. Objective: To investigate the theory that coronary heart disease (CHD) mortality in patients with type 2 diabetes with no prior CHD evidence is equal to patients with diagnosed myocardial infarction (MI) or prior evidence of CHD without diabetes. Methods: The original study population included 1059 patients with type 2 diabetes and 1373 normal patients who were followed up for 7 years. Data analysis was not done separately for men and women, and MI was the only criterion used for CHD. In this reanalysis, the follow-up was prolonged to 18 years, using mortality from CHD, cardiovascular disease (CVD), and all causes as endpoints. Results have been analyzed separately for men and women. Four categories of prior evidence of CHD were defined: prior MI verified at the hospital, angina pectoris, ischemic electrocardiographic changes, any prior evidence of CHD. All laboratory specimens were taken following a 12-hour fast. Multivariate Cox regression models were used to examine the association of CV risk factors with endpoints. Results: Median follow-up was 17.5 years. During this period, 76 (11.9%) nondiabetic men, 17 (2.3%) nondiabetic women, 331 (38%) diabetic men, and 156 (32.6%) diabetic women died of CHD. Age and duration of diabetes did not significantly affect the hazard ratios of diabetic subjects without prior MI compared with those for nondiabetic subjects with prior MI. The results for CVD and total mortality were similar to those for CHD mortality. In contrast, diabetes status was a stronger predictor for non-CVD mortality compared with prior CHD in men, but not in women. The results were significant (P < 0.01) in all subjects in both sexes, regardless of the definition used for prior CHD. Conclusions: The study indicates that type 2 diabetes is a risk factor for CHD mortality in men and women. Diabetes without prior CHD evidence indicates a higher risk than prior evidence of any CHD in patients without diabetes.