Diabetes and cardiovascular disease. The Framingham study

Area of Science:

• Cardiology
• Endocrinology
• Epidemiology

Background:

• Diabetes mellitus is a significant risk factor for cardiovascular disease (CVD).
• Previous studies suggest a link between diabetes and increased CVD events, but the differential impact across various conditions and sexes requires further elucidation.

Purpose of the Study:

• To quantify the risk of subsequent clinical atherosclerotic disease in individuals with diabetes.
• To examine the differential impact of diabetes on various cardiovascular events (coronary heart disease, intermittent claudication, congestive heart failure, stroke) and mortality.
• To compare the relative and absolute risks between men and women with diabetes.

Main Methods:

• Longitudinal surveillance of the Framingham cohort over 20 years.
• Analysis relating prior evidence of diabetes to subsequent cardiovascular events.
• Statistical adjustment for other associated risk factors.

Main Results:

• Diabetes confers a twofold to threefold increased risk of clinical atherosclerotic disease.
• The relative impact of diabetes was greatest for intermittent claudication (IC) and congestive heart failure (CHF), and least for coronary heart disease (CHD).
• Absolute risk of CHD was the chief sequela of diabetes.
• The relative impact of diabetes was substantially greater for women than for men, with higher morbidity and mortality for diabetic women across most CVDs.
• After risk factor adjustment, diabetes impact on CHD, IC, or stroke incidence was similar for both sexes, but greater for women regarding CVD death and CHF.

Conclusions:

• Diabetes is a major independent risk factor for multiple clinical atherosclerotic diseases.
• Women with diabetes face a disproportionately higher relative risk for several cardiovascular outcomes compared to men.
• Diabetic women experience substantial cardiovascular morbidity and mortality, comparable to diabetic men for overall cardiovascular mortality.