Family history of myocardial infarction predicts incident coronary heart disease in postmenopausal women with diabetes: the Women's Health Initiative Observational Study

Li, Rongling; OʼSullivan, Mary J.; Robinson, Jennifer G.; Safford, Monika M.; Curb, David; Johnson, Karen C.

doi:10.1002/dmrr.1010

Cited by 9 publications

(5 citation statements)

References 25 publications

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“…The survival function was affected by both the number of relatives with CAD (p = 0.0002) as well as when CAD was considered premature (p = 0.004). Importantly, this study was fully adjusted for many covariates including systolic and diastolic blood pressure, smoking, race, lipid medication, physical activity and others [ 22 ].…”

Section: How To Identify the High Risk Patient?mentioning

confidence: 99%

Cardiovascular risk assessment in patients with diabetes

Bertoluci

Rocha

2017

Diabetol Metab Syndr

184

123

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Although patients with diabetes have 2 to 4 times increased risk of cardiovascular morbidity and mortality than individuals without diabetes, recent studies indicate that a significant part of patients are in a lower cardiovascular risk category. Men younger than 35 years, women younger than 45 years, patients with diabetes duration of less than 10 years without other risk factors have a much lower risk than patients who have traditional cardiovascular risk factors, and subclinical or established coronary artery disease (CAD). These patients are not risk equivalent as stated in previous studies. On the contrary, when in the presence of traditional risk factors or evidence of subclinical coronary disease (e.g. high coronary calcium score), the coronary risk is much increased and patients may be classified at a higher-risk category. Recent guidelines do not anymore consider diabetes as a CAD risk equivalent and recommend cardiovascular risk stratification for primary prevention. Stratification of diabetic patients improves accuracy in prediction of subclinical CAD, silent ischemia and future cardiovascular events. Stratification also discriminates higher from lower risk patients who may need intensive statin or aspirin prevention, while avoiding overtreatment in lower risk cases. It may also allow the clinician to decide whether to intensify risk reduction actions through specific newer drugs for glucose control such as SGLT-2 inhibitors or GLP-1 agonists, which recently have shown additional cardiovascular protector effect. This review addresses the assessment of cardiovascular disease risk using traditional and non-traditional cardiovascular risk factors. It also reviews the use of risk calculators and new reclassification tools, focusing on the detection of subclinical atherosclerosis as well as silent ischemia in the asymptomatic patients with diabetes.

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Section: How To Identify the High Risk Patient?mentioning

confidence: 99%

Cardiovascular risk assessment in patients with diabetes

Bertoluci

Rocha

2017

Diabetol Metab Syndr

184

123

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“…Ten studies (15,16,21,24–26,29,31–33) validated the instrument for measuring PA, and quantification of PA was allowed in seven studies (15,16,24,25,29,31,33) of which six (15,16,25,29,31,33) and five (24,25,29,31,33) studies assessed ACM and CVD risk, respectively. Only two studies (27,31) exclusively used medical records for ascertainment of CVD. None of the 13 studies evaluating the risk of ACM used medical records.…”

Section: Resultsmentioning

confidence: 99%

Association Between Physical Activity and Risk of All-Cause Mortality and Cardiovascular Disease in Patients With Diabetes

et al. 2013

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OBJECTIVEThe association between habitual physical activity (PA) and lowered risk of all-cause mortality (ACM) and cardiovascular disease (CVD) has been suggested in patients with diabetes. This meta-analysis summarizes the risk reduction in relation to PA, focusing on clarifying dose-response associations.RESEARCH DESIGN AND METHODSElectronic literature searches were conducted for cohort studies that examined relative risk (RR) of ACM or CVD in relation to PA in patients with diabetes. For the qualitative assessment, RR for the highest versus the lowest PA category in each study was pooled with a random-effects model. We added linear and spline regression analyses to assess the quantitative relationship between increases in PA and ACM and CVD risk.RESULTSThere were 17 eligible studies. Qualitatively, the highest PA category had a lower RR [95% CI] for ACM (0.61 [0.52–0.70]) and CVD (0.71 [0.60–0.84]) than the lowest PA category. The linear regression model indicated a high goodness of fit for the risk of ACM (adjusted R2 = 0.44, P = 0.001) and CVD (adjusted R2 = 0.51, P = 0.001), with the result that a 1 MET-h/day incrementally higher PA was associated with 9.5% (5.0–13.8%) and 7.9% (4.3–11.4%) reductions in ACM and CVD risk, respectively. The spline regression model was not significantly different from the linear model in goodness of fit (P = 0.14 for ACM risk; P = 0.60 for CVD risk).CONCLUSIONSMore PA was associated with a larger reduction in future ACM and CVD risk in patients with diabetes. Nevertheless, any amount of habitual PA was better than inactivity.

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“…In a meta -analysis of 11 studies examining the association between physical activity and CVD in adults with diabetes, higher levels of physical activity were associated with a lower relative risk of CVD [11] . However, the authors note less than half of the studies adjusted for the classic CVD risk factors of age, sex, smoking, dyslipidemia and hypertension, with the only diabetes-related factor accounted for, in just three studies, was diabetes severity [30] , [31] , [32] .…”

Section: Discussionmentioning

confidence: 99%