Diabetes and Cardiovascular Risk Equivalency: Do Age at Diagnosis and Disease Duration Affect Risk Stratification?

Idris, Iskandar

doi:10.1001/archinternmed.2010.524

Cited by 4 publications

(2 citation statements)

References 9 publications

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“…Of note, 61.5% of patients in this cohort used statins, and HbA 1C was a stronger predictor than LDL cholesterol of risk of death from any cause. Moreover, some studies have demonstrated that only patients who have had diabetes for at least 10 to 15 years have an increased risk of CVD events. In 1 of these studies, only 31% of patients with diabetes and 66% of those with diabetes and coronary heart disease used statins at baseline.…”

Section: Discussionmentioning

confidence: 99%

Association of Statin Therapy Initiation With Diabetes Progression

et al. 2021

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IMPORTANCEStatin therapy has been associated with increased insulin resistance; however, its clinical implications for diabetes control among patients with diabetes is unknown. OBJECTIVE To assess diabetes progression after initiation of statin use in patients with diabetes. DESIGN, SETTING, AND PARTICIPANTSThis was a retrospective matched-cohort study using new-user and active-comparator designs to assess associations between statin initiation and diabetes progression in a national cohort of patients covered by the US Department of Veterans Affairs from fiscal years 2003-2015. Patients included were 30 years or older; had been diagnosed with diabetes during the study period; and were regular users of the Veterans Affairs health system, with records of demographic information, clinical encounters, vital signs, laboratory data, and medication usage. INTERVENTIONS Treatment initiation with statins (statin users) or with H2-blockers or proton pump inhibitors (active comparators).MAIN OUTCOMES AND MEASURES Diabetes progression composite outcome comprised the following: new insulin initiation, increase in the number of glucose-lowering medication classes, incidence of 5 or more measurements of blood glucose of 200 mg/dL or greater, or a new diagnosis of ketoacidosis or uncontrolled diabetes. RESULTSFrom the 705 774 eligible patients, we matched 83 022 pairs of statin users and active comparators; the matched cohort had a mean (SD) age of 60.1 (11.6) years; 78 712 (94.9%) were men; 1715 (2.1%) were American Indian/Pacific Islander/Alaska Native, 570 (0.8%) were Asian, 17 890 (21.5%) were Black, and 56 633 (68.2 %) were White individuals. Diabetes progression outcome occurred in 55.9% of statin users vs 48.0% of active comparators (odds ratio, 1.37; 95% CI, 1.35-1.40; P < .001). Each individual component of the composite outcome was significantly higher among statin users. Secondary analysis demonstrated a dose-response relationship with a higher intensity of low-density lipoprotein-cholesterol lowering associated with greater diabetes progression. CONCLUSIONS AND RELEVANCEThis retrospective matched-cohort study found that statin use was associated with diabetes progression, including greater likelihood of insulin treatment initiation, significant hyperglycemia, acute glycemic complications, and an increased number of prescriptions for glucose-lowering medication classes. The risk-benefit ratio of statin use in patients with diabetes should take into consideration its metabolic effects.

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Section: Discussionmentioning

confidence: 99%

Association of Statin Therapy Initiation With Diabetes Progression

et al. 2021

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“…The difficulty in dissecting out the contribution of diabetes duration to the risk of macrovascular events is twofold. Firstly, age, age at onset of diabetes and duration of diabetes are inter-related, as age is the sum of the other two variables (22). Secondly, duration of diabetes increases linearly with age.…”

Section: Discussionmentioning

confidence: 99%

Diabetes, Myocardial Infarction and Stroke Are Distinct and Duration-Dependent Predictors of Subsequent Cardiovascular Events and All-Cause Mortality in Older Men

Yeap

McCaul

Flicker

et al. 2015

The Journal of Clinical Endocrinology & Metabolism

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In older men, increasing duration of diabetes predicts stable increases in all-cause and MI-related mortality and a progressively higher risk of stroke deaths. Prior MI was associated with increased risk of subsequent MI, and prior stroke with subsequent stroke, particularly in the 10-20 years following the first event. Diabetes is a duration-dependent risk factor for cardiovascular events which influences outcomes differently from prior vascular disease.

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Diabetes and Prior Coronary Heart Disease are Not Necessarily Risk Equivalent for Future Coronary Heart Disease Events

et al. 2015

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BACKGROUND: For more than a decade, the presence of diabetes has been considered a coronary heart disease (CHD) Brisk equivalent^. OBJECTIVE: The objective of this study was to revisit the concept of risk equivalence by comparing the risk of subsequent CHD events among individuals with or without history of diabetes or CHD in a large contemporary realworld cohort over a period of 10 years (2002 to 2011). DESIGN: Population-based prospective cohort analysis. PARTICIPANTS: We studied a cohort of 1,586,061 adult members (ages 30-90 years) of Kaiser Permanente Northern California, an integrated health care delivery system. MAIN MEASUREMENTS: We calculated hazard ratios (HRs) from Cox proportional hazard models for CHD among four fixed cohorts, defined by prevalent (baseline) risk group: no history of diabetes or CHD (None), prior CHD alone (CHD), diabetes alone (DM), and diabetes and prior CHD (DM+CHD). KEY RESULTS: We observed 80,012 new CHD events over the follow-up period (~10,980,800 person-years). After multivariable adjustment, the HRs (reference: None) for new CHD events were as follows: CHD alone, 2.8 (95 % CI, 2.7-2.85); DM alone 1.7 (95 % CI, 1.66-1.74); DM+CHD, 3.9 (95 % CI, 3.8-4.0). Individuals with diabetes alone had significantly lower risk of CHD across all age and sex strata compared to those with CHD alone (12.2 versus 22.5 per 1000 person-years). The risk of future CHD for patients with a history of either DM or CHD was similar only among those with diabetes of long duration (≥10 years). CONCLUSIONS: Not all individuals with diabetes should be unconditionally assumed to be a risk equivalent of those with prior CHD.

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Diabetes and Cardiovascular Risk Equivalency: Do Age at Diagnosis and Disease Duration Affect Risk Stratification?

Cited by 4 publications

References 9 publications

Association of Statin Therapy Initiation With Diabetes Progression

Association of Statin Therapy Initiation With Diabetes Progression

Diabetes, Myocardial Infarction and Stroke Are Distinct and Duration-Dependent Predictors of Subsequent Cardiovascular Events and All-Cause Mortality in Older Men

Diabetes and Prior Coronary Heart Disease are Not Necessarily Risk Equivalent for Future Coronary Heart Disease Events

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