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Diabetes and coronary heart disease as risk factors for mortality in older adults
Mercedes R Carnethon1, Mary L Biggs, Joshua Barzilay
1Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. carnethon@northwestern.edu
Insights
In older adults, type 2 diabetes poses a cardiovascular mortality risk comparable to established coronary heart disease (CHD). This highlights the significant public health impact of both conditions, especially in women.
Area of Science:
- Gerontology
- Cardiology
- Endocrinology
Background:
- Type 2 diabetes is often considered a coronary heart disease (CHD) risk equivalent.
- Older adults commonly have both glucose disorders and atherosclerosis.
- This study investigated mortality rates in older adults with prevalent CHD versus diabetes.
Purpose of the Study:
- To compare cardiovascular and all-cause mortality between older adults with prevalent CHD and those with diabetes.
- To assess the risk equivalence of diabetes and established CHD in an aging population.
Main Methods:
- Longitudinal Cardiovascular Health Study (n=5784) of adults aged 65+.
- Follow-up from 1989/1992-1993 through 2005 for mortality.
- Diabetes defined by fasting plasma glucose ≥7.0 mmol/L or medication use; prevalent CHD by history of myocardial infarction, angina, or revascularization.
Main Results:
- Adjusted CHD mortality risk was similar between CHD alone and diabetes alone (HR 1.04).
- Mortality attributable to diabetes and CHD was similar in women, but higher for CHD in men.
- Diabetes alone conferred a similar cardiovascular mortality risk as established CHD in older adults.
Conclusions:
- Diabetes alone presents a cardiovascular mortality risk comparable to established clinical CHD in older adults.
- The public health burden of diabetes and CHD is substantial, with a notable impact on women.
Background:
Type 2 diabetes has been described as a coronary heart disease (CHD) "risk equivalent." We tested whether cardiovascular and all-cause mortality rates were similar between participants with prevalent CHD vs diabetes in an older adult population in whom both glucose disorders and preexisting atherosclerosis are common.
Methods:
The Cardiovascular Health Study is a longitudinal study of men and women (n=5784) aged > or =65 years at baseline who were followed from baseline (1989/1992-1993) through 2005 for mortality. Diabetes was defined by fasting plasma glucose > or =7.0 mmol/L or use of diabetes control medications. Prevalent CHD was determined by confirmed history of myocardial infarction, angina, or coronary revascularization.
Results:
Following multivariable adjustment for other cardiovascular disease risk factors and subclinical atherosclerosis, CHD mortality risk was similar between participants with CHD alone vs diabetes alone (hazard ratio [HR] 1.04, 95% confidence interval [CI], 0.83-1.30). The proportion of mortality attributable to prevalent diabetes (population-attributable risk percent=8.4%) and prevalent CHD (6.7%) was similar in women, but the proportion of mortality attributable to CHD (16.5%) as compared with diabetes (6.4%) was markedly higher in men. Patterns were similar for cardiovascular disease mortality. By contrast, the adjusted relative hazard of total mortality was lower among participants with CHD alone (HR 0.85, 95% CI, 0.75-0.96) as compared with those who had diabetes alone.
Conclusions:
Among older adults, diabetes alone confers a risk for cardiovascular mortality similar to that from established clinical CHD. The public health burden of both diabetes and CHD is substantial, particularly among women.
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