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- Title
Comparison of Prevalent Diabetes and Coronary Heart Disease (CHD) as Risk Factors for CHD Mortality in Older Men and Women: Cardiovascular Health Study.
- Authors
Carnethon, Mercedes R.; Mukamal, Kenneth; Biggs, Mary L.; Barzilay, Joshua; Mozzafarian, Dariush; Smith, Nicholas L.; Kuller, Lewis H.; Siscovick, David
- Abstract
Type 2 diabetes mellitus (DM) is considered a CHD "risk equivalent" for fatal CHD in prior studies of predominately middle-aged adults. In a population sample of men and women aged ≥ 65 years, we compared the risk of fatal CHD among persons who had prevalent DM but no CHD to that of persons who were free from DM but had CHD. We classified 2456 men and 3328 women (mean age = 72.8) from the Cardiovascular Health Study by their DM (fasting plasma glucose ≥ 7.0 mmol/L or use of DM control medications) and CHD (confirmed history of myocardial infarction, angina, coronary artery angioplasty, or coronary bypass surgery) status at baseline. Using sex-specific Cox proportional hazards modeling, we compared the risk of CHD mortality (history of ischemic CHD on medical record or chest pain within 72 hours of death) in participants with DM and no prevalent CHD to those with prevalent CHD and no DM, both prevalent CHD and DM, and neither. Over a mean 10.4 years of follow-up, the crude CHD mortality rates were 18.1 and 8.9 per 1000 person-years in men and women, respectively. As compared with men with DM alone, the hazard ratio (HR) of CHD mortality among men with CHD alone was slightly elevated whereas the HR for CHD alone was slightly lower among women (interaction P = 0.21). There was no difference in CHD mortality between women with CHD alone as compared to those with only DM. Further adjustment for inflammatory markers, fibrinolytic factors and subclinical atherosclerosis did not alter the results substantially. Findings were similar for cardiovascular (including stroke)- and all-cause mortality. DM may be considered a CHD risk equivalent for mortality in older women. However, among men prevalent CHD confers a slightly greater risk of mortality than DM alone.
- Subjects
TYPE 2 diabetes; CORONARY disease; MORTALITY; GLUCOSE; FIBRINOLYTIC agents; ATHEROSCLEROSIS
- Publication
Diabetes, 2007, Vol 56, pA243
- ISSN
0012-1797
- Publication type
Article