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Diabetes doubles risk for CV events
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ADA 70th Scientific Sessions
ORLANDO — Patients with diabetes have a about a twofold increased risk for cardiovascular diseases, including myocardial infarction and stroke, independent of other conventional risk factors, new data reveal.
Only a small part of the effects of diabetes was explained by lipids, blood pressure and obesity, according to researchers.
Results were derived from a collaborative meta-analysis of individual data from 102 prospective studies included in the Emerging Risk Factors Collaboration database. Researchers analyzed records of 698,782 participants, of which 52,765 had non-fatal or fatal CV outcomes. Follow-up was about 10 years.
Adjusted HRs with diabetes were 2 for coronary heart disease (95% CI, 1.83-2.9); 2.27 for ischemic stroke (95% CI, 1.95-2.65); 1.56 for hemorrhagic stroke (95% CI, 1.19-2.05); 1.84 for unclassified stroke (95% CI, 1.59-2.13); and 1.73 for all other CV-associated deaths (95% CI, 1.51-1.98). Of note, HRs did not change when researchers further adjusted for lipid, inflammatory or renal markers.
“Little of the vascular risk associated with diabetes is explained in markers of obesity, lipids, blood pressure, inflammation or renal function. Outstanding uncertainties include consideration of diabetes type and duration,” Nadeem Sarwar, PhD, lecturer in CV epidemiology at the University of Cambridge, England, said at the Joint ADA/The Lancet Symposium.
According to the researchers’ estimations, diabetes accounted for 11% of vascular deaths, at an adult population-wide prevalence of 10%.
The researchers reported a non-linear relationship between fasting glucose concentrations and vascular risk, with no significant association at values between 3.9 mmol/L and 5.59 mmol/L.
The progressive relationship between elevated glucose levels and vascular outcomes may be linked to a wide range of other factors, including lipid metabolism, fat deposition in tissue and liver function, Hertzel C. Gerstein, MD, of McMaster University and Hamilton Health Sciences, Ontario, Canada, wrote in an accompanying editorial published in The Lancet.
For more information:
- Sarwar N. Joint ADA/The Lancet Symposium. Presented at: The American Diabetes Association 70th Scientific Sessions; June 25-29, 2010; Orlando.
- The Emerging Risk Factors Collaboration. Lancet. 2010; 375:2215-2222.
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