Diabetes and Long-Term Risk of Mortality From Coronary and Other Causes in Middle-Aged Swedish Men: A general population study

Adlerberth, Annika; Rosengren, Annika; Wilhelmsen, Lars

doi:10.2337/diacare.21.4.539

Cited by 87 publications

(58 citation statements)

References 30 publications

(69 reference statements)

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“…Findings in those that have are inconsistent. Several analyses have reported similar associations between total cholesterol or LDL-cholesterol and cardiovascular outcomes in patients with and without diabetes [2,4,11,12]. However, in the largest analysis conducted to date [3], the relationship between total cholesterol and risk of CVD in people with diabetes was reported to be weaker than that among individuals without diabetes (13 vs 28% excess risk of CVD associated with a 1 mmol/l increase in the level of total cholesterol), although it is not clear whether this difference was statistically significant.…”

Section: Discussionmentioning

confidence: 91%

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Cholesterol, diabetes and major cardiovascular diseases in the Asia-Pacific region

2007

Diabetologia

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Aims/hypothesis The aim of this study was to assess the association between total cholesterol and major cardiovascular diseases among persons with and without diabetes in the Asia-Pacific region. Methods We used data on individual participants in 30 cohort studies from the Asia-Pacific region to compute the hazards ratios and 95% CIs for participants with and without diabetes at baseline, using Cox proportional models. Analyses were stratified by sex and region (Asia vs Australia or New Zealand) and adjusted for age. Repeat measurements of total cholesterol were used to adjust for regression dilution bias. Results The analysis included 333,533 individuals (6.3% with diabetes at baseline) who experienced 6,074 fatal and non-fatal cardiovascular events over a median follow-up period of 4.0 years. Total cholesterol was positively associated with coronary heart disease (CHD) and ischaemic stroke, and negatively with haemorrhagic stroke in a continuous, log-linear fashion, similarly among participants with and without diabetes. Each 1 mmol/l increase above the 'usual' level for total cholesterol was associated with a 41% (95% CI 23-63%) and 42% (95% CI 35-50%) greater risk of CHD among participants with and without diabetes. The corresponding values for ischaemic stroke were 23% (95% CI 0-52%) and 31% (95% CI 20-44%), respectively. These results were broadly consistent for sex, age and region. Conclusions/interpretation Total cholesterol is associated with similarly increased risks of cardiovascular events in people with and without diabetes. While abnormal levels of other lipid fractions are frequently observed in people with diabetes, these data support aggressive lowering of total cholesterol and LDL-cholesterol levels for prevention of cardiovascular events.

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Section: Discussionmentioning

confidence: 91%

“…The major importance of diabetes mellitus as an independent risk factor for cardiovascular disease (CVD) is well established and consistent across populations [1,2]. Diabetes is associated with a two-to fourfold risk of cardiovascular events and cardiovascular death [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Cholesterol, diabetes and major cardiovascular diseases in the Asia-Pacific region

2007

Diabetologia

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“…36) to 100%. 37 The covariables accounted for in the analyses included ethnicity, 37,39 sex, [36][37][38][39][40] age, [36][37][38][39][40] body mass index, 36,39,40 smoking, [36][37][38]40 alcohol intake, 40 physical activity, 40 education, 40 history of cardiovascular disease, 36,39 serum cholesterol, 36,37,39,40 or albuminuria. 37 Masked hypertension was associated with increased risk both in non-diabetic subjects and in patients with diabetes, without any significant interaction.…”

Section: Discussionmentioning

confidence: 99%

Are blood pressure and diabetes additive or synergistic risk factors? Outcome in 8494 subjects randomly recruited from 10 populations

Sehestedt

Hansen

et al. 2011

Hypertens Res

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It remains unknown whether diabetes and high blood pressure (BP) are simply additive risk factors for cardiovascular outcome or whether they act synergistically and potentiate one another. We performed 24-h ambulatory BP monitoring in 8494 subjects (mean age, 54.6 years; 47.0% women; 6.9% diabetic patients) enrolled in prospective population studies in 10 countries. In multivariable-adjusted Cox regression, we assessed the additive as opposed to the synergistic effects of BP and diabetes in relation to a composite cardiovascular endpoint by testing the significance of appropriate interaction terms. During 10.6 years (median follow-up), 1066 participants had a cardiovascular complication. Diabetes mellitus as well as the 24-h ambulatory BP were independent and powerful predictors of the composite cardiovascular endpoint. However, there was no synergistic interaction between diabetes and 24-h, daytime, or nighttime, systolic or diastolic ambulatory BP (P for interaction, 0.07pPp0.97). The only exception was a borderline synergistic effect between diabetes and daytime diastolic BP in relation to the composite cardiovascular endpoint (P¼0.04). In diabetic patients, with normotension as the reference group, the adjusted hazard ratios for the cardiovascular endpoint were 1.35 (95% confidence interval (CI), 0.87-2.11) for white-coat hypertension, 1.78 (95% CI, 1.22-2.60) for masked hypertension and 2.44 (95% CI, 1.92-3.11) for sustained hypertension. The hazard ratios for non-diabetic subjects were not different from those of diabetic patients (P-values for interaction, 0.09pPp0.72).In conclusion, in a large international population-based database, both diabetes mellitus and BP contributed equally to the risk of cardiovascular complications without evidence for a synergistic effect.

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“…Comments have been made on the inconsistences in the findings of these studies even regarding the role of the classical CVD risk factors, blood pressure, serum cholesterol and cigarette smoking [2]. Of these only one small study was negative [25]; the largest one involving patients screened for the Multiple Risk Factor Intervention Trial (MRFIT) [14], the UK Prospective Diabetes Study (UKPDS) [52] and our study have clearly shown that all these three risk factors are predictive of CVD mortality in patients with Type II diabetes.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for cardiovascular mortality and morbidity: The WHO multinational study of vascular disease in diabetes.

2001

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Type I (insulin-dependent) and Type II (non-insulindependent) diabetes mellitus are characterised by an increased risk of cardiovascular disease (CVD) in men and women [1]. In particular there is an excess incidence of coronary heart disease (CHD) and stroke in people with diabetes. However the role of the cardiovascular factors increasing the risk of CVD in diabetes in the general population has remained controversial [2]. In order to plan cost-effective cardiovascular interventions in diabetic patients, the strength of the relation between various putative Diabetologia (2001)

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Diabetes and Long-Term Risk of Mortality From Coronary and Other Causes in Middle-Aged Swedish Men: A general population study

Cited by 87 publications

References 30 publications

Cholesterol, diabetes and major cardiovascular diseases in the Asia-Pacific region

Cholesterol, diabetes and major cardiovascular diseases in the Asia-Pacific region

Are blood pressure and diabetes additive or synergistic risk factors? Outcome in 8494 subjects randomly recruited from 10 populations

Risk factors for cardiovascular mortality and morbidity: The WHO multinational study of vascular disease in diabetes.

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