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Diabetes mellitus and arteriographically-documented coronary artery disease
D S Freedman1, H W Gruchow, V S Bamrah
1Division of Biostatistics and Clinical Epidemiology, Medical College of Wisconsin, Milwaukee 53226.
Insights
Diabetes significantly increases coronary artery disease (CAD) risk, especially in women. This risk is independent of other factors, with female diabetics showing a greater CAD burden, potentially due to increased atherosclerosis.
Area of Science:
- Cardiology
- Endocrinology
- Epidemiology
Background:
- Diabetes mellitus is a known risk factor for coronary heart disease (CHD).
- The independent association between diabetes and coronary artery disease (CAD) requires further investigation, particularly concerning sex differences and other risk factors.
Purpose of the Study:
- To examine the independent relationship between diabetes mellitus and arteriographically-documented coronary artery disease (CAD).
- To investigate potential sex differences in the association between diabetes and CAD.
- To assess the impact of diabetes on CAD severity in relation to other cardiovascular risk factors.
Main Methods:
- A cohort of 5620 patients referred for coronary angiography was studied.
- Diabetes status was determined by questionnaire, with 8% of patients diagnosed with diabetes mellitus.
- Coronary artery disease severity was assessed by the number and severity of stenoses, with adjustments for cholesterol, hypertension, obesity, smoking, and alcohol consumption.
Main Results:
- Diabetics exhibited increased CAD compared to non-diabetics, independent of other major risk factors.
- Female diabetics showed a trend towards greater CAD than male diabetics (p=0.06).
- Female diabetics using oral hypoglycemics or insulin had a nearly two-fold increase in CAD severity (p<0.01).
Conclusions:
- Diabetes is an independent risk factor for significant coronary artery disease.
- The heightened risk of CHD in female diabetics may stem from a greater progression of atherosclerosis.
- Diabetes management, particularly with medication, warrants attention for its impact on CAD severity in women.
Abstract:
Diabetics are at increased risk for coronary heart disease even after accounting for other risk factors, and the impact of diabetes mellitus may be particularly strong among females and at adverse levels of other risk factors. Therefore, the independent relation of diabetes to arteriographically-documented coronary artery disease (CAD) was examined in 5620 patients (18% female) referred to two Milwaukee hospitals from 1972 to 1986. As assessed by questionnaire, the prevalence of diabetes mellitus among these patients was 8% (n = 466). Diabetics had increased CAD (assessed by the number and severity of stenoses) even after accounting for levels of total and high-density lipoprotein cholesterol, triglycerides, hypertension, obesity, smoking, and alcohol consumption. In addition, regression analyses indicated that as compared with nondiabetics, female diabetics tended to have a greater increase in CAD than did male diabetics (p = 0.06 for sex x diabetes interaction). Although adverse levels of other risk factors did not increase the association between diabetes and CAD, female diabetics who were using oral hypoglycemics or insulin showed almost a two-fold increase in CAD severity (p less than 0.01). Results suggest that the higher relative risk of coronary heart disease among female (vs male) diabetics may be due to a proportionately greater increase in atherosclerosis.