Abstract P333: Diabetes: Coronary Heart Disease Risk Equivalent or Risk Factor? The REasons for Geographic and Racial Differences in Stroke Study
Evidence is mixed regarding whether diabetes confers an equivalent risk of coronary heart disease (CHD) as prior myocardial infarction (MI). We assessed the hypotheses that 1) diabetes is a CHD risk equivalent and 2) severe diabetes is a CHD risk equivalent in the REasons for Geographic and Racial Differences in Stroke study population (30,239 black and white US adults ≥ 45 years recruited 2003-2007 with follow-up through 2011 for CHD). Diabetes at baseline was assessed using blood glucose (fasting ≥ 126 mg/dL or non-fasting ≥ 200 mg/dL) or self-reported use of diabetes medication. CHD at baseline was assessed using electrocardiogram evidence of MI or self-report of MI or revascularization. The primary exposure groups were diabetes only, CHD only, both diabetes and CHD, and neither CHD nor diabetes at baseline. We further stratified individuals with diabetes only at baseline by self-reported insulin use or albuminuria (urinary albumin-to-creatinine ratio ≥ 30 mg/g) to identify more severe diabetes. We conducted Kaplan-Meier curves with log-rank tests and Cox proportional hazards models adjusted for demographics, CHD risk factors and CHD prevention medications. Of 25,739 participants analyzed, 11.8% had CHD only, 15.6% had diabetes only, 5.9% had both CHD and diabetes, and 66.7% had neither at baseline. The rate of CHD was lower among participants with diabetes only compared to those with CHD only at baseline (hazard ratio (HR): 0.65 (95% CI: 0.54, 0.77)). The rate of CHD was similar comparing participants with more severe diabetes to participants with CHD only at baseline (Figure, HR: 0.91 (95% CI: 0.70, 1.17) for participants with diabetes and insulin, HR: 0.89 (95% CI: 0.71, 1.13) for participants with diabetes and albuminuria). In conclusion, diabetes requiring insulin or in combination with albuminuria was associated with similar risk of CHD as baseline CHD, but less severe diabetes was not. Severity of diabetes should be considered when deciding whether diabetes should be treated as a CHD risk factor or risk equivalent.
Author Disclosures: F.L. Mondesir: None. T.M. Brown: None. P. Muntner: None. R.W. Durant: None. M.M. Safford: None. E.B. Levitan: None.
- © 2015 by American Heart Association, Inc.