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Duration of diabetes linked to increased risk of MI, stroke in older men
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A longer duration of diabetes appears to be associated with increased risk for macrovascular events and mortality in older men, according to recent findings published in The Journal of Clinical Endocrinology & Metabolism.
In the longitudinal study, Bu Beng Yeap, MBBS, PhD, of Fremantle Hospital in Australia, and colleagues randomly recruited 11,728 men aged 65 years or older from the electoral rolls in Perth, Western Australia, between 1996 and 1999. The men attended a clinic and responded to a questionnaire addressing the following demographic and clinical characteristics: height, weight, blood pressure, smoking status, alcohol use, exercise, dietary habits, history of coronary heart disease (CHD), treatment for CHD, stroke, hypertension, dyslipidemia and diabetes.
Follow-up data were collected until Dec. 31, 2010. The study’s primary outcomes were defined as death from any cause and myocardial infarction (MI) or stroke-related hospital admissions or deaths. Age-specific hazard was determined and adjusted for smoking, education, alcohol, BMI, hypertension and hypercholesterolemia.
The researchers found that 1,433 participants had diabetes, and the age at onset was as follows: 14.5% reported onset at 55 years, 31.5% at 55-64 years, 47.4% at 65-74 years and 6.6% > 74 years.
Based on diabetes duration, diabetes was found to be an independent predictor of all-cause mortality with the following hazard ratios: 1.37 (95% CI, 1.15-1.62) for 5-9 years duration, 1.35 (95% CI, 1.18-1.55) for 10-14 years duration, 1.42 (95% CI, 1.22-1.66) for 15-19 years duration and 1.75 (95% CI, 1.45-2.11) for 20-24 years duration.
There was an increase in MI-related mortality for diabetes duration up to 25 years, and stroke-related death increased in proportion to diabetes duration. Previous MI or stroke was linked to increased risk of future MI or stroke, with this risk reaching its peak 10 to 20 years after the initial event.
“In conclusion, our results indicate that in men, diabetes continues to function as either a marker for or a contributor to macrovascular events and mortality even in advanced old age,” the researchers wrote. “Increased longevity does not protect against the higher risk of death, MI and stroke associated with diabetes, once diabetes has been present for longer than 5 years. Current guidelines support careful personalization of glucose-lowering therapy in older persons living with diabetes; and our findings indicate the risks of macrovascular disease do not diminish with increasing duration of disease.” – by Jennifer Byrne
Disclosure: Yeap reports receiving an award from the Sylvia and Charles Viertel Charitable Foundation.
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