Duration of Diabetes and Prediabetes During Adulthood and Subclinical Atherosclerosis and Cardiac Dysfunction in Middle Age: The CARDIA Study

Reis, Jared P.; Allen, Norrina B.; Bancks, Michael P.; Carr, Jeff; Lewis, Cora E.; Lima, João A.C.; Rana, Jamal S.; Gidding, Samuel S.; Schreiner, Pamela J.

doi:10.2337/dc17-2233

Cited by 78 publications

(64 citation statements)

References 40 publications

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“…Women were reported to have 2 years longer duration of prediabetes than men [37]. Longer duration of prediabetes has been shown to be associated with left ventricular systolic and diastolic dysfunction [38]. Finally, it is also possible that sex differences in other cardiovascular risk factor profiles [30][31][32][33][39][40][41] account for the greater excess risk of heart failure associated with diabetes in women compared with men.…”

Section: Discussionmentioning

confidence: 99%

Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals

et al. 2019

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Aims/hypothesis The prevalence of diabetes and heart failure is increasing, and diabetes has been associated with an increased risk of heart failure. However, whether diabetes confers the same excess risk of heart failure in women and men is unknown. The aim of this study was to conduct a comprehensive systematic review with meta-analysis of possible sex differences in the excess risk of heart failure consequent to diabetes. Our null hypothesis was that there is no such sex difference. Methods A systematic search was conducted in PubMed for population-based cohort studies published between January 1966 and November 2018. Studies were selected if they reported sex-specific estimates of RRs for heart failure associated with diabetes, and its associated variability, which were adjusted at least for age. Random-effects meta-analyses with inverse variance weighting were used to obtain pooled sex-specific RRs and women-to-men ratio of RRs (RRRs) for heart failure associated with diabetes. Results Data from 47 cohorts, involving 12,142,998 individuals and 253,260 heart failure events, were included. The pooled multiple-adjusted RR for heart failure associated with type 1 diabetes was 5.15 (95% CI 3.43, 7.74) in women and 3.47 (2.57, 4.69) in men, leading to an RRR of 1.47 (1.44, 1.90). Corresponding pooled RRs for heart failure associated with type 2 diabetes were 1.95 (1.70, 2.22) in women and 1.74 (1.55, 1.95) in men, with a pooled RRR of 1.09 (1.05, 1.13). Conclusions/interpretation The excess risk of heart failure associated with diabetes is significantly greater in women with diabetes than in men with diabetes. PROSPERO registration: CRD42019135246

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Section: Discussionmentioning

confidence: 99%

Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals

et al. 2019

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“…A few studies with varying estimates of the CVD risk have assessed the impact of IFG/IGT with or without conversion to diabetes [8][9][10][11]; however, it's difficult to compare the results due to the different sample size, age Table 2 HRs (95% (CI) of CVD and CHD for subjects with incident IR and those with changing IR status between baseline and the first follow-up (n = 803) Incident IR, those who converted from IS state to IR state. IR and IS among men was defined as HOMA-IR ≥ 2.17 µU/mL and < 2.17 µU/mL, respectively; corresponding values form women were ≥ 1.85 µU/mL and < 1.85 µU/mL respectively [23] IR, insulin resistance; IS, insulin sensitive; HR, hazard ratios; CI, confidence interval; CVD, cardiovascular disease; CHD, coronary heart disease a Model 1: Age, sex of participants, duration of changes in glucose category states and type and number of confounders [26].…”

Section: Discussionmentioning

confidence: 99%

Change in glucose intolerance status and risk of incident cardiovascular disease: Tehran Lipid and Glucose Study

Kabootari

Hasheminia

Azizi

et al. 2020

Cardiovasc Diabetol

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Background: To assess the impact of changes in different glucose tolerance states on risk of incident cardiovascular disease (CVD)/coronary heart disease (CHD). Methods: A total of 4094 Iranians (43.9% men) aged ≥ 30 years, without diabetes and CVD at enrolment were included. The following categories were defined both at baseline visit and 3 years later (second visit): normal fasting glucose (NFG), normal glucose tolerance (NGT), NFG and NGT (NFG/NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and IFG and/or IGT (IFG/IGT). Changes in the categories, i.e. regression to normoglycemia, remaining in previous status and progression to diabetes were assessed. We used Cox's proportional hazard models adjusted for traditional risk factors and their changes, to estimate the hazard ratio (HR) with 95% confidence interval (CI) of different changing categories for incident CVD/CHD. Results: During a median follow-up of 12.42 years, 428 subjects (men = 265) experienced CVD. Considering persistent NFG/NGT as reference, participants who shifted from NFG/NGT to IFG/IGT showed a lower hazard of CVD in the fully adjusted model, HR 0.72 [95% CI 0.52-0.996, P = 0.048]. Moreover, subjects who shifted from IFG, IGT and IFG/IGT to diabetes had an increased risk of CVD/CHD. The risk however, was only statistically significant for those with IFG/ IGT, 1.61 [(1.03-2.51), P = 0.04] for CVD and 1.75 [(1.10-2.78), P = 0.02] for CHD; considering IFG/IGT at both visits as reference. Furthermore, those who regressed from IFG/IGT to normoglycemia were at the same risk as those remained in IFG/IGT state, 1.12 [(0.79-1.60), P = 0.52] for CVD and 1.04 [(0.70-1.53), P = 0.85] for CHD. Among a subgroup of population with insulin data (n = 803) those with insulin resistance (IR) that converted to diabetes showed a higher risk for CVD, 3.68 [(1.49-9.06), P = 0.01] and CHD, 2.76 [(1.00-7.60), P = 0.05] events in the fully adjusted model. Conclusions: Among participants with IFG, IGT or IFG/IGT at baseline, only those who developed diabetes had a higher risk of developing CVD/CHD. Persistent IFG/IGT was not associated with higher risk, compared with those reverted to normoglycemia. Moreover, subjects who converted from NFG/NGT to incident IFG/IGT showed a signal for lower risk of CVD/CHD.

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“…The large population of young adults with diabetes is of concern for several reasons. First, the presence of diabetes among youth and young adults increases their exposure to chronic hyperglycemia and accompanying cardiometabolic risk factors early in life, which increase the risk of cardiovascular disease (6), kidney failure (7), and lifetime diabetes complications (8) in middle age and can contribute to the reduced life expectancy of young adults with diabetes (9). Second, compared with older adults, young adults may be less likely to be aware of type 2 diabetes or cardiometabolic risk factors (10), which may lead to delayed (or nonexistent) risk factor management among this population.…”

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confidence: 99%

The Cardiometabolic Risk Profile of Young Adults With Diabetes in the U.S.

et al. 2019

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We examined young adults with and young adults without diabetes by using demographic data and cardiometabolic risk profiles and compared the risk profiles of younger versus older (aged ‡45 years) adults with diabetes. RESEARCH DESIGN AND METHODS Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2016. Diabetes was defined by self-report of health care provider diagnosis or by A1C levels of 6.5% or higher among those without a self-reported diagnosis. The cardiometabolic risk profile included adiposity, blood pressure, serum lipids, healthy eating, physical activity (PA), and exposure to tobacco smoke. Adjusted difference in difference was calculated as the difference among younger adults with and younger adults without diabetes minus the difference among older adults with and older adults without diabetes. RESULTS Adults with diabetes in both age-groups had higher levels of adiposity, hypertension, and cholesterol and lower levels of healthy eating and leisure-time PA. However, the differences in high cholesterol and adiposity by diabetes status were greater among young adults compared with older adults after adjustment for demographics and health insurance status. Elevated lipids were 9.6 percentage points higher (95% CI 4.6, 14.5) and obesity was 37.3 percentage points higher (95% CI 31.8, 42.7) among young adults with diabetes compared with those without diabetes than among older adults with diabetes compared with those without diabetes. CONCLUSIONS Young adults with diabetes have high rates of cardiometabolic risk factors, which can lead to an increased disease prevalence and mortality rate among these individuals as they age. Amid well-documented increases in diabetes prevalence in the U.S. (1), the relative increases among youth aged 10-20 years have been the largest and most alarming (2,3). As of 2015, 4.6 million young adults aged 18-44 years had diabetes (1.6 million of whom were undiagnosed) (4), reflecting an annual percentage increase in prevalence of 4.3% since 1988-1994 (5). This increase in diabetes prevalence has resulted in a new cohort of young adults with potentially higher rates of morbidity (and subsequent use of health care) in early adulthood than ever before in the U.S.

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Duration of Diabetes and Prediabetes During Adulthood and Subclinical Atherosclerosis and Cardiac Dysfunction in Middle Age: The CARDIA Study

Abstract: Durations of diabetes and prediabetes during adulthood are both independently associated with subclinical atherosclerosis and left ventricular systolic and diastolic dysfunction in middle age.

Cited by 78 publications

References 40 publications

Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals

Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals

Change in glucose intolerance status and risk of incident cardiovascular disease: Tehran Lipid and Glucose Study

The Cardiometabolic Risk Profile of Young Adults With Diabetes in the U.S.

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