Heart Care Info - Heart Disease Prevention & Treatment

Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk ...

SG Wannamethee, AG Shaper... - Archives of internal ..., 2011 - Am Med Assoc Methods A prospective study of 4045 men aged 60 to 79 years followed up for a mean of 9 years, during which there were 372 major coronary heart disease (CHD) events (fatal and nonfatal myocardial infarction [MI]), 455 deaths from cardiovascular disease, and 1112 deaths ...

Diabetes mellitus is associated with increased risk of cardiovascular disease (CVD), including coronary heart disease (CHD), in middle-aged and older populations,1 - 6 although the relative effects of diabetes on CVD are weaker among older adults.5 - 6 The increased CVD risk associated with diabetes is not fully explained by traditional CVD risk factors.6 Although diabetes is a well-established risk factor for CHD, whether diabetes alone is a CHD equivalent7 in assessing the risk of future CVD events is controversial. In some8 - 11 but not all studies,7 ,12 CHD risk among people with diabetes has been shown to be equivalent to that among people with prior myocardial infarction (MI). Moreover, the influence of age at onset and duration on the impact of diabetes on CVD risk is not fully established. Earlier studies have suggested that the impact of diabetes on mortality decreases with increasing age at onset.13 - 14 It has been reported that the characteristics of those diagnosed before age 65 years differ from the characteristics of those diagnosed after age 65 years,15 and some studies have suggested that onset at a later age is not associated with increased mortality.12 ,16 However, these findings have not been supported by all studies.17 - 19 The impact of late onset of diabetes on CHD risk in older adults, in whom absolute CHD risk is high, and the issue of whether late onset (and thus shorter duration) of diabetes confers a risk similar to that of prior MI have been less well studied. A better understanding of the relationship between diabetes and CHD in older people and in relation to diabetes duration could be important for strategies aimed at reducing cardiovascular risk in older adults with diabetes. We have examined the relationship between age at onset of diabetes and risk of major CHD events, CVD, and all-cause mortality among men aged 60 to 79 years. Because markers of inflammation, endothelial dysfunction, and renal dysfunction are related to CVD and diabetes,20 - 21 we have assessed the contributing role of these factors and linked CVD risk markers with the increased CVD risk associated with diabetes. Our analyses may help reconcile apparently contradictory results on the risk of CHD in patients with diabetes.