Diabetes and Coronary Heart Disease as Risk Factors for Mortality in Older Adults
Open accessAbstract
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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The weighted average death rate from cardiovascular disease among patients with type 2 diabetes across eight studies was 9.9% (95% CI 8.6-11.3%).
“The weighted average of death rates from the eight studies with 3,208,557 patients with T2DM was 9.9% (95% CI 8.6–11.3%) [29–36].”
From Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017 (2018) · cites this paper as [32]
Comparing patients with both type 2 diabetes and cardiovascular disease with patients having neither, the odds ratio for death was 4.56 (95% CI 3.53-5.89).
“Comparing patients with both T2DM and CVD with patients having neither T2DM nor CVD, the odds ratio for death was 4.56 (95% CI 3.53–5.89) [32].”
From Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017 (2018) · cites this paper as [32]
Using a weighted average from seven studies, deaths due to cardiovascular disease comprised 50.3% (95% CI 37.0-63.7%) of all deaths in patients with type 2 diabetes.
“Using a weighted average from seven studies (N = 86,557) [29–35], the calculated deaths due to CVD comprised 50.3% (95% CI 37.0–63.7%) of all deaths in patients with T2DM.”
From Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017 (2018) · cites this paper as [32]
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Self-citation
- Authors
- Carnethon, M. R., Biggs, M. L., Barzilay, J., Kuller, L. H., Mozaffarian, D., Mukamal, K., Smith, N. L., & Siscovick, D.
- Affiliations
- Northwestern University (US)
- University of Washington (US)
- Kaiser Permanente (US)
- University of Pittsburgh (US)
- Brigham and Women's Hospital (US)
- Beth Israel Deaconess Medical Center (US)
- United States Department of Veterans Affairs (US)
- Corresponding author
- Carnethon, Mercedes R.
- ORCID
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2010-06
- Volume
- 123
- Issue
- 6
- Pages
- 556.e1-556.e9
- ISSN
- 0002-9343 (ISSN-L)
- PMC
- PMC3145803
- OpenAlex
- W2002067755
- Cited by
- 77
- References
- 28
- Citations by year
- 2026: 2 · 2024: 3 · 2023: 5 · 2022: 8 · 2021: 3 · 2020: 3 · 2019: 7 · 2018: 3 · 2017: 5 · 2016: 2 · 2015: 5 · 2014: 9 · 2013: 7 · 2012: 5
- FWCI
- 5.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute
- National Institute of Neurological Disorders and Stroke
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- type 2 diabetes, coronary artery disease, cardiovascular mortality, all-cause mortality, older adults, sex differences, population attributable risk, subclinical atherosclerosis, Cardiovascular Health Study, risk equivalence
- MeSH terms
- Aged, Coronary Disease, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Male, Risk Factors, Time Factors, United States, Prevalence, Survival Rate, Sex Distribution
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