Diabetes and obesity in Northern Sweden: occurrence and risk factors for stroke and myocardial infarction

Abstract

Aims: The authors describe the occurrence of diabetes and obesity in the population of Northern Sweden and the role of diabetes in cardiovascular disease. Methods: Four surveys of the population aged 25 to 64 years were undertaken during a 14-year time span. Stroke events in subjects 35 -74 years during 1985 -92 and myocardial infarction in subjects 25 -64 years 1989 -93 were registered. Results: The prevalence of diagnosed diabetes was 3.1 and 2.0% in men and women, respectively, and 2.6 and 2.7% for previously undiagnosed diabetes. During the 13-year observation period, BMI increased 0.96 kg/m 2 in men and 0.87 in women. The proportion of subjects with obesity (BMI¢30) increased from 10.3% to 14.6% in men and from 12.5% to 15.7% in women. Hip circumference increased substantially more than waist circumference, leading to a decreasing waits-to-hip ratio (WHR). The relative risk for stroke or myocardial infarction was four to six times higher in a person with diabetes than in those without diabetes. The 28-day case fatality for myocardial infarction, but not for stroke, was significantly higher in both men and women with diabetes. Population-attributable risk for diabetes and stroke was 18% in men and 22% in women and for myocardial infarction it was 11% in men and 17% in women. Conclusion: Obesity is becoming more common, although of a more distal than central distribution. The burden of diabetes in cardiovascular diseases in Northern Sweden is high.

Age and gender differences in the impact of diabetes on the prevalence of ischemic heart disease: a population-based register study

“…Since type 2 diabetes is the most common form of the disease, and considering that macrovascular complications are confined primarily to type 2 diabetes, it is reasonable to assume that the results of our study can be attributed to type 2 diabetes. The prevalence of diabetes in our county population corresponds very well with previous estimations presented in the Swedish Public Health Report 2005 [28], which refers to a recent follow-up of the project Northern Sweden World Health Organization Monitoring of Trends and Determinants in Cardiovascular Disease (designated WHO NSW MONICA) [29]. The prevalence rates of diabetes mellitus presented in that report are identical to our data; 5.4% among men and 4.0% among women aged 25-74 years, which strongly supports the validity of the diabetes data in the CDWÖ.…”

Favorable Trends in the Incidence and Outcome in Stroke in Nondiabetic and Diabetic Subjects

“…18 In addition, the proportion of DM diagnosed with oral glucose tolerance test (OGTT) was stable over time in the background population between 1986 and 2004 as based on the data from the 5 MONICA population surveys in the same area and population. 18,40 For the age group 65 to 74 years, prevalence of known diabetes is available from 3 surveys, 1994 to 2004, and OGTT from 1994 and 2004. Therefore, we believe our estimates on incidence of stroke among the diabetic population are as valid as would be possible to achieve.…”

High levels of tissue plasminogen activator (tPA) antigen precede the development of type 2 diabetes in a longitudinal population study. The Northern Sweden MONICA Study

“…The risk of stroke and myocardial infarction is considerably increased in subjects with diabetes [1]. Already at the time of diagnosis of type 2 diabetes, many patients have manifest cardiovascular disease (CVD) [2].…”