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Diabetes, diabetes severity, and coronary heart disease risk equivalence: REasons for Geographic and Racial Differences in Stroke (REGARDS).

TitleDiabetes, diabetes severity, and coronary heart disease risk equivalence: REasons for Geographic and Racial Differences in Stroke (REGARDS).
Publication TypeJournal Article
Year of Publication2016
AuthorsMondesir, FL, Brown, TM, Muntner, P, Durant, RW, Carson, AP, Safford, MM, Levitan, EB
JournalAm Heart J
Volume181
Pagination43-51
Date Published2016 Nov
ISSN1097-6744
Abstract

BACKGROUND: Evidence is mixed regarding whether diabetes confers equivalent risk of coronary heart disease (CHD) as prevalent CHD. We investigated whether diabetes and severe diabetes are CHD risk equivalents.METHODS: At baseline, participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (black and white US adults ≥45 years old recruited in 2003-2007) were categorized as having prevalent CHD only (self-reported or electrocardiogram evidence; n = 3,043), diabetes only (self-reported or elevated glucose; n = 4,012), diabetes and prevalent CHD (n = 1,529), and neither diabetes nor prevalent CHD (n = 17,155). Participants with diabetes using insulin and/or with albuminuria (urinary albumin-to-creatinine ratio ≥30 mg/g) were categorized as having severe diabetes. Participants were followed up through 2011 for CHD events (myocardial infarction or fatal CHD).RESULTS: During a mean follow-up of 5 years, 1,385 CHD events occurred. The hazard ratios of CHD events comparing participants with diabetes only, diabetes, and prevalent CHD and neither diabetes nor prevalent CHD with those with prevalent CHD were 0.65 (95% CI 0.54-0.77), 1.54 (95% CI 1.30-1.83), and 0.41 (95% CI 0.35-0.47), respectively, after adjustment for demographics and risk factors. Compared with participants with prevalent CHD, the hazard ratio of CHD events for participants with severe diabetes was 0.88 (95% CI 0.72-1.09).CONCLUSIONS: Participants with diabetes had lower risk of CHD events than did those with prevalent CHD. However, participants with severe diabetes had similar risk to those with prevalent CHD. Diabetes severity may need consideration when deciding whether diabetes is a CHD risk equivalent.

DOI10.1016/j.ahj.2016.08.002
Alternate JournalAm. Heart J.
PubMed ID27823692
PubMed Central IDPMC5117821
Grant ListK01 DK095928 / DK / NIDDK NIH HHS / United States
K24 HL111154 / HL / NHLBI NIH HHS / United States
R01 HL080477 / HL / NHLBI NIH HHS / United States
U01 NS041588 / NS / NINDS NIH HHS / United States