Abstract 17105: Lifecourse Analysis Reveals Adverse Cardiovascular Disease Risk Factor Profiles up to 30 Years Prior to the Diagnosis of Diabetes
Introduction: Individuals with diabetes have a 2-4 fold increased risk of developing cardiovascular disease (CVD), even after accounting for CVD risk factors. Most models of diabetes have only examined risk factors at the time of diabetes diagnosis instead of considering the lifetime burden of adverse risk factor levels. By using a lifecourse approach to examine risk factors among individuals with and without diabetes, we examined the 30-year risk factor burden that participants carry up to the time of diabetes diagnosis
Methods: Among participants free of clinical CVD, incident diabetes (defined as fasting plasma glucose >=126 mg/dl or treatment) cases at the 8th examination cycle (2005-2008) of the Framingham Heart Study Offspring cohort were age and sex-matched 1:3 to controls. CVD risk factors (hypertension [blood pressure >=140/90 mm Hg or treatment], high LDL cholesterol [LDL >=130 mg/dL or treatment], HDL cholesterol, triglycerides, and body mass index) were measured at the eighth examination and at time points 10, 20, and 30 years prior to the exam. Conditional logistic regression was used to compare risk factor levels at each time point between diabetes cases and controls.
Results: We identified 127 participants with new-onset diabetes who were matched to 381 controls (mean age 68 years, 41% women). Compared to those without diabetes, individuals who eventually developed diabetes had higher levels of hypertension, triglycerides, and body mass index and lower levels of HDL cholesterol compared to those without diabetes (Table). There was no difference in the prevalence of high LDL cholesterol between diabetes cases and controls.
Conclusions: CVD risk factors are elevated up to 30 years prior to the diagnosis of diabetes. The lifetime elevated burden of CVD risk factors likely contributes to the increased CVD risk observed among individuals with diabetes. These findings highlight the importance of a lifecourse approach to CVD risk factor identification.
- © 2010 by American Heart Association, Inc.