Cardiovascular Risk Factors and Impaired Glucose Tolerance: The San Luis Valley Diabetes Study

Abstract

Cardiovascular risk factor patterns were examined cross-sectionally in 856 Hispanic and Anglo subjects aged 20-74 years enrolled in the population-based San Luis Valley Diabetes Study of Colorado. Risk factor levels and prevalence were compared for 279 individuals with non-insulin-dependent diabetes mellitus, 89 with impaired glucose tolerance, and 488 with normal glucose tolerance. Sex-specific comparisons of continuous risk factors were made by diabetic status and ethnicity, adjusting for age using two-way analysis of covariance; similar comparisons of discrete variables were made using logistic regression. A number of vascular, metabolic, lipid, obesity-related, family history, and life-style risk factors for cardiovascular disease were examined. In general, biologic risk factors tended to be more strongly associated with diabetic status, while life-style risk factors varied more by ethnicity. Age-adjusted levels of systolic and diastolic blood pressure, hypertension history, triglyceride, and body mass index were lowest among normal subjects, intermediate for those with impaired glucose tolerance, and highest in subjects with non-insulin-dependent diabetes mellitus, while the trend was reversed for high density lipoprotein (HDL) cholesterol and its subfractions. Hispanics had lower serum uric acid levels and greater central obesity than Anglos; they were less likely to have a Type A personality, less physically active at work, and more likely to be a current smoker than Anglos. Hispanic males had a lower body mass index and a higher HDL cholesterol level than Anglo males. These results indicate that an adverse cardiovascular risk factor pattern is present not only in subjects with non-insulin-dependent diabetes mellitus but also in subjects with impaired glucose tolerance who are at increased risk of developing diabetes. This suggests that an adverse risk factor pattern may develop concurrently with or prior to the onset of impaired glucose tolerance. Future prospective studies will help to clarify the temporal sequence involved in the development of adverse cardiovascular risk factor patterns and impaired glucose tolerance.

Impaired glucose tolerance – is it relevant for cardiovascular disease?

“…Burchfiel et al [7] found that subjects with IGT had increased cardiovascular risk factors (decreased high density lipoprotein (HDL) cholesterol and increased triglyceride, blood pressure, and plasma insulin) intermediate between subjects with NGT and NIDDM. In a study of elderly subjects, Mykkä nen et al [8] found that men and women with IGT had significantly higher total triglycerides, apolipoprotein B (apo B) and lower HDL cholesterol and apo A than men and women with NGT.…”

Insulin secretion and insulin sensitivity in relation to glucose tolerance: lessons from the Botnia Study.

“…Subjects with impaired glucose tolerance (IGT) are at an increased risk of developing diabetes and cardiovascular disease (6)(7)(8)(9). However, diagnosis of IGT requires an oral glucose tolerance test (OGTT), the use of which was abandoned by the ADA.…”

Postchallenge Hyperglycemia and Mortality in a National Sample of U.S. Adults

“…However, few of these previous studies have been conducted in a sample representative of the general U.S. population (4,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)20). Moreover, it is unclear whether this excess mortality is conferred by PCH per se or rather by fasting hyperglycemia or CVD risk factors that commonly accompany diabetes, such as high blood pressure, dyslipidemia, and obesity (1,(21)(22)(23)(24)(25). Although there is mounting evidence of the importance of PCH, the prognostic value of this measure in the general U.S. population, especially as it relates to mortality, remains unclear.…”