Risk factors other than hyperglycemia in diabetic macrovascular disease.

A five-year prospective follow-up study was done on 10,000 adult males in Israel. The end-points of diabetes mellitus--clinical and unrecognized myocardial infarction, angina pectoris, sudden death, and hypertension--were examined. The incidence rates rise with age and vary significantly by areas of birth, with the Middle Eastern and North African subjects having the highest incidence of diabetes but the lowest cardiovascular rates. A developmental medical model based on a historical-societal perspective is proposed to explain these findings. The major factors found on multivariate analysis in the development of diabetes mellitus are compared with those of the other cardiovascular end-points mentioned above. The similarities and differences between these risk factors are discussed, and I conclude that the prevention or alleviation of diabetic macrovascular disease needs a multifactorial approach against the major risk factors of the macrovascular complications as well as those related to diabetes, in the individual, family, and community.