Diabetes, body mass index and the excess risk of coronary heart disease, ischemic and hemorrhagic stroke in the Asia Pacific Cohort Studies Collaboration

Murakami, Yoshitaka; Huxley, Rachel R.; Lam, Tai Hing; Tsukinoki, Rumi; Fang, Xianghua; Kim, Hyeon Chang; Woodward, Mark

doi:10.1016/j.ypmed.2011.10.010

Cited by 19 publications

(11 citation statements)

References 13 publications

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“…This project is ongoing and is being constantly updated and expanded by recruiting other cohort studies. The study collaborators are constantly encouraged to conduct new analyses, and, in particular, to undertake interaction analyses 10 , 11 and evaluations of absolute risk. 4 In these analyses, we tested for interaction, or the effect when 2 risk factors co-occur, using a likelihood ratio test to compare goodness-of-fit of the main model against that of the alternative model including the interaction terms.…”

Section: Discussion and Future Directionsmentioning

confidence: 99%

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Meta-analyses Using Individual Participant Data From Cardiovascular Cohort Studies in Japan: Current Status and Future Directions

Murakami

2014

Journal of Epidemiology

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Meta-analysis of individual participant data (IPD meta-analysis) has several advantages over meta-analysis using aggregated published data, including the possibility of using statistical methods such as a fine stratification analysis, interaction analysis between 2 risk factors, and absolute risk estimation. The Evidence for Cardiovascular Prevention from Observational Cohorts in Japan Study (EPOCH-JAPAN), which was initiated in 2005, is a collaborative research project for IPD meta-analysis and includes 13 participating cohort studies in Japan. We generated 2 pooled databases with data on all-cause mortality (n = 199 047) and cardiovascular outcomes (n = 90 528) and applied a stratified Cox model to account for the different baseline hazards between cohorts. The results of our analyses show the age- and sex-specific associations between all-cause and cardiovascular disease mortality and established cardiovascular risk factors (blood pressure, smoking, total cholesterol, proteinuria, and kidney function). During the 9 years of its existence, the results generated by EPOCH-JAPAN have had important implications for clinical medicine and public health policy in Japan. The project is expected to draw upon new analytical methods such as interaction analysis and absolute risk evaluation in the near future. We believe that, over the next decade, this project will continue to provide new insights that can be applied to research on other Asian populations.

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Section: Discussion and Future Directionsmentioning

confidence: 99%

“…The most significant advantage of this approach for interaction analyses is that it allows us to draw comprehensive conclusions regarding the presence of interaction effects. 10 , 11 …”

Section: Discussion and Future Directionsmentioning

confidence: 99%

Meta-analyses Using Individual Participant Data From Cardiovascular Cohort Studies in Japan: Current Status and Future Directions

Murakami

2014

Journal of Epidemiology

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“…For all categories of BMI, the risk for coronary heart disease, stroke and total cardiovascular disease was approximately twofold higher in patients with diabetes compared with those without diabetes. However, when assessed across different BMI categories, increased BMI was not significantly associated with cardiovascular risk in patients with diabetes (p = 0.19) [74].…”

Section: Obesity and Metabolic Syndromementioning

confidence: 92%

“…In addition to the three individual studies, the literature review process identified two pooled/meta-analyses that looked at the role of obesity/overweight in cardiovascular risk in Type 2 diabetes [74,75]. In one analysis of five US-based longitudinal studies, Carnethon et al actually report a nonsignificantly higher risk (HR [95% CI] 1.29 [0.71-2.33]) for cardiovascular mortality for patients in the normal weight category at diagnosis of Type 2 diabetes relative to those who were overweight or obese at the time of diagnosis [75].…”

Section: Obesity and Metabolic Syndromementioning

confidence: 99%

“…The authors note that this finding was unexpected and postulate that part of this increased risk may be due to lower body weight being indicative of weight loss and/or muscle wasting due to underlying disease. The second meta-analysis included 31 studies from the AsiaPacific Cohort Studies Collaboration in a total of 161,161 patients, 6446 (4%) of whom had diabetes [74]. For all categories of BMI, the risk for coronary heart disease, stroke and total cardiovascular disease was approximately twofold higher in patients with diabetes compared with those without diabetes.…”

Section: Obesity and Metabolic Syndromementioning

confidence: 99%

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Cardiovascular risk profiles in Type 2 diabetes and the impact of geographical setting

Smith-Palmer¹,

Boye

Pérez-Nieves

et al. 2014

Expert Review of Endocrinology & Metabolism

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Cardiovascular (CV) disease is a leading morbidity and mortality in Type 2 diabetes (T2DM). Previous studies have shown geographic differences in the prevalence of CV and renal diseases. A literature review of longitudinal ( ‡5 years) studies including ‡1000 T2DM patients and reporting CV endpoints was performed to compare risk profiles. Key differences between geographies included a relatively higher prevalence of microalbuminuria in East Asian relative to North American and European patients, which in turn is an important CV risk factor. Patients from East Asia also have a relatively higher incidence of stroke and lower incidence of coronary heart disease. Overall, there are differences in CV risk in T2DM patients between different regions and that long-term studies from Africa, the Middle East and Latin America are lacking.

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Type 2 diabetes in midlife and risk of cerebrovascular disease in late life: a prospective nested case−control study in a nationwide Swedish twin cohort

Yang

Pedersen

Bao³

et al. 2019

Diabetologia

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Aims/hypothesis We aimed to examine the association between midlife type 2 diabetes mellitus and cerebrovascular disease (CBD) in late life, and further to explore whether genetic and early-life familial environmental factors (such as shared childhood socioeconomic status and adolescent environment) play a role in this association. Methods In this prospective nested case−control study based on the Swedish Twin Registry, 33,086 twin individuals who were born in 1958 or earlier and were CBD-free before the age of 60 were included. Midlife (40–59 years) type 2 diabetes was ascertained from self-report, the National Patient Registry (NPR) and glucose-lowering medication use. CBD diagnosis (cerebral infarction, occlusion of cerebral arteries, subarachnoid haemorrhage, intracerebral haemorrhage and unspecified CBD) and onset age were identified from the NPR. Late-life CBD was defined as CBD onset age ≥60 years. Generalised estimating equation (GEE) models were used to analyse unmatched case−control data (adjusted for the clustering of twins within a pair). Conditional logistic regression was used in co-twin matched case−control analyses in CBD-discordant twin pairs. Results Of all the participants, 1248 (3.8%) had midlife type 2 diabetes and 3121 (9.4%) had CBD in late life. In GEE models adjusted for age, sex, education, BMI, smoking, alcohol consumption, marital status, hypertension and heart disease, the ORs (95% CIs) of type 2 diabetes were 1.29 (1.03, 1.61) for cerebral infarction, 2.03 (1.20, 3.44) for occlusion of cerebral arteries, 0.52 (0.12, 2.21) for subarachnoid haemorrhage and 0.78 (0.45, 1.36) for intracerebral haemorrhage. In multi-adjusted conditional logistic regression, the OR of the type 2 diabetes–cerebral infarction association was 0.96 (0.51, 1.80). The differences in ORs from the GEE and co-twin control analyses were not statistically significant ( p = 0.780). Conclusions/interpretation Midlife type 2 diabetes is significantly associated with increased risk of cerebral infarction and occlusion of cerebral arteries, but not intracerebral haemorrhage or subarachnoid haemorrhage in late life. Genetic and early-life familial environmental factors do not appear to account for the type 2 diabetes–cerebral infarction association, but further clarification is needed. Electronic supplementary material The online version of this article (10.1007/s00125-019-4892-3) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

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Diabetes, body mass index and the excess risk of coronary heart disease, ischemic and hemorrhagic stroke in the Asia Pacific Cohort Studies Collaboration

Cited by 19 publications

References 13 publications

Meta-analyses Using Individual Participant Data From Cardiovascular Cohort Studies in Japan: Current Status and Future Directions

Meta-analyses Using Individual Participant Data From Cardiovascular Cohort Studies in Japan: Current Status and Future Directions

Cardiovascular risk profiles in Type 2 diabetes and the impact of geographical setting

Type 2 diabetes in midlife and risk of cerebrovascular disease in late life: a prospective nested case−control study in a nationwide Swedish twin cohort

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