Diabetes Mellitus in Women Can be RUTHless
Lessons From the Raloxifene Use for The Heart (RUTH) Trial
Since 1998, when Haffner et al1 reported that adults from Finland with type 2 diabetes mellitus (DM) were at the same risk for future myocardial infarction as adults with previous myocardial infarction, guidelines have increasingly advocated that people with DM are cardiovascular disease (CVD) risk equivalents and should be treated as secondary prevention. However, since that time, mixed results have been obtained by evaluating other cohorts, with several results not being able to demonstrate that adults with DM achieve a 20% 10-year risk. This concept of cardiac risk equivalency with DM has come under scrutiny.
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The investigators of the Raloxifene Use for the Heart (RUTH) trial2 thus evaluated a very large cohort of women and followed them up for CVD events and all-cause mortality to evaluate this premise. This trial demonstrated that women with DM without known coronary heart disease (CHD) had a lower risk of nonfatal CHD and CVD events compared with women without DM and with CHD, but their risk of CHD mortality, CVD mortality, and all-cause mortality was similar to the risk of those with CHD and no DM. These results support the hypothesis that women with DM are at increased risk but do not achieve secondary prevention targets as …