© 2000 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Diabetes Mellitus
Subclinical Cardiovascular Disease and Risk of Incident Cardiovascular Disease and All-Cause Mortality
From the Graduate School of Public Health (L.H.K.), Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa; the CHS Coordinating Center (P.V.), Century Square Building, Seattle, Wash; Kaiser Permanente of Georgia (J.B.), Tucker, Ga; Neuroradiology Division (N.J.B.), Johns Hopkins Radiology, Baltimore, Md; Department of Radiology (D.H.O.), Tufts-New England Medical Center, Boston, Mass; and Division of Epidemiology and Clinical Applications/National Heart, Lung, and Blood Institute (P.J.S.), Bethesda, Md.
Correspondence to Lewis H. Kuller, MD, DrPH, University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Room A527, 130 DeSoto St, Pittsburgh, PA 15261. E-mail kuller+{at}pitt.edu
Abstract—Previously diagnosed diabetes mellitus, newly diagnosed diabetes mellitus, and impaired glucose tolerance are important determinants of the risk of clinical cardiovascular disease (CVD). We have evaluated the relation of patients with subclinical CVD, diabetes, and impaired glucose tolerance and "normal" subjects and the risk of clinical CVD in the Cardiovascular Health Study. Diabetes (1343), impaired glucose tolerance (1433), and normal (2421) were defined by World Health Organization criteria at baseline in 1989 to 1990. The average follow-up was 6.4 years (mean age 73 years). Diabetics had a higher prevalence of clinical and subclinical CVD at baseline. Compared with diabetes in the absence of subclinical disease, the presence of subclinical CVD and diabetes was associated with significant increased adjusted relative risk of death (1.5, CI 0.93 to 2.41), relative risk of incident coronary heart disease (1.99, CI 1.25 to 3.19), and incident myocardial infarction (1.93, CI 0.96 to 3.91). The risk of clinical events was greater for participants with a history of diabetes compared with newly diagnosed diabetics at baseline. Compared with nondiabetic nonhypertensive subjects without subclinical disease, patients with a combination of diabetes, hypertension, and subclinical disease had a 12-fold increased risk of stroke. Fasting blood glucose levels were a weak predictor of incident coronary heart disease as were most other risk factors. Subclinical CVD was the primary determinant of clinical CVD among diabetics in the Cardiovascular Health Study.
Key Words: diabetes • atherosclerosis • subclinical disease • stroke • heart attack
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