Abstract 19772: The Significance of Blood Pressure on Cardiovascular Risk Attributable to Diabetes
Background: Diabetes mellitus (DM) is an established risk factor of atherosclerotic cardiovascular events (CVE). Individuals with DM often have elevated levels of blood pressure (BP) which is closely associated with CVE.
Hypothesis: The risk of DM-related CVE may depend on BP levels.
Methods: A population-based prospective cohort study was performed in 24,350 subjects aged 40 to 89 years (mean age = 63.0±10.0 years) who did not have a history of CVE. DM was defined as a casual blood glucose level ≥ 200 mg/dl or fasting blood glucose level ≥ 126 mg/dl, a glycated hemoglobin value ≥ 6.5%, and/or current anti-diabetic therapy. BP levels at the baseline examination were classified into three categories including normotension, pre-hypertension, and hypertension according to JNC7. This classification was applied also to subjects with antihypertensive agents use. After adjustment for age, sex, body mass index, eGFR, total and HDL cholesterol, smoking habits, and anti-hypertensive medication use, a multivariate Cox regression analysis was performed to examine an association and contribution of pre-hypertension and hypertension on the risk of CVE in DM and non DM.
Results: During a mean follow-up period of 5.5 years, 746 subjects developed CVE which was defined as stroke or acute myocardial infarction/sudden cardiac death. In both DM and non DM, the hazard ratios for CVE were increased in pre-hypertensives (HR 1.25, p < 0.05; HR 2.59, p < 0.02, respectively) and in hypertensives (HR 1.82, p < 0.01; HR 3.66, p < 0.01, respectively) in comparison with normotensives. However, the population-attributable fractions (PAFs) of pre-hypertension and hypertension were apparently higher in DM (21.5%, 41.2%, respectively), as these were more than double compared to PAFs in non DM (6.7%, 20.3%, respectively).
Conclusions: Approximately two-third of excess CVE attributable to DM is estimated to occur among individuals with elevated BP levels.
Author Disclosures: R. Komi: None. F. Tanaka: None. S. Makita: None. T. Onoda: None. K. Tanno: None. M. Ohsawa: None. K. Itai: None. K. Sakata: None. S. Omama: None. K. Ogasawara: None. Y. Ishibashi: None. A. Okayama: None. M. Nakamura: None.
- © 2014 by American Heart Association, Inc.