[health-vn] Diabetes Mellitus, Fasting Blood Glucose Concentration, and Risk of Vascular Disease

[vern weitzel]

From: "ProCor" <procor at procor.org>
Date: 2 August 2010 9:08:59 AM PDT
To: "Global Dialogue" <procor at list.procor.org>
Subject: [procor] Diabetes Mellitus, Fasting Blood Glucose Concentration, and Risk of Vascular Disease
Reply-To: "Global Dialogue" <procor at list.procor.org>

Findings from this meta-analysis involving data from 25 countries reinforce the importance of diabetes on the development of several vascular diseases of major public health importance...

Title: Diabetes Mellitus, Fasting Blood Glucose Concentration, and Risk of Vascular Disease: A Collaborative Meta-Analysis of 102 Prospective Studies

Authors: The Emerging Risk Factors Collaboration

Reference: Lancet 2010; 375:2215-22 (open access) 
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960484-9/abstract

Reviewer: Robert Goldberg, PhD, Contributing editor, ProCor; Professor of Medicine and Epidemiology, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA

Reviewer comments: Diabetes is considered to be a coronary heart disease (CHD) equivalent and this metabolic disorder has been consistently associated with an increased risk for CHD in a variety of population settings in which this relation has been examined. The relationship between diabetes and other manifestations of cardiovascular disease (CVD) is less apparent, however, as is the association of fasting blood glucose levels and development of different clinical CVD related events.

The results of the present meta-analysis confirm prior findings from a number of prospective epidemiologic studies that suggest that diabetes is associated with a markedly increased risk for CHD, stroke, and deaths due to other vascular causes. Moreover, based on the author's estimates, upwards of 10% of all vascular deaths in developed countries might be attributable to diabetes, or more than one quarter of a million deaths annually. On the other hand, impaired glucose tolerance was less strongly associated with the development of CHD and stroke than clinically diagnosed diabetes.

These findings reinforce the importance of diabetes on the development of several vascular diseases of major public health importance, including CHD and stroke. Moreover, based on the results of this meta-analysis, the adverse events associated with this metabolic disorder appear to be of similar impact in the various age, sex, and coronary risk factor groups examined, including those at comparatively low absolute risk for vascular disease. These findings were broadly consistent in the 25 countries that contributed data to this meta-analysis suggesting the importance of diabetes in both developed and developing nations. As the authors conclude, future observational studies should examine the association of additional markers of dysglycemia and insulin resistance with fatal and non-fatal vascular endpoints and examine the consistency of these associations in persons at varying risk for these untoward events. Data from these studies would allow for the more systematic targeting and testing of future pharmacologic and nonpharmacologic interventions to those at varying risk for both the prediabetes state, clinically apparent diabetes, and important vascular diseases.

Purpose of study: To examine, through the meta-analysis of prospective observational studies, the association between diabetes mellitus, fasting blood glucose levels, and risk of fatal and non-fatal vascular disease.

Location of study: Cambridge, England

Study design: Meta-analysis

Results: The authors carried out a systematic search of the published literature, identifying a total of 121 prospective studies that were carried out in 25 countries of vascular risk factors in more than 1.2 million adults. Of these, 102 observational studies satisfied the investigators pre-defined inclusion criteria and more than 530,000 people without a history of either CHD or stroke were included.

Overall, the mean age of participants at the time of study entry was 52 years and 43% were women. A total of nearly 39,000 persons (7%) reported a history of diabetes at baseline and the prevalence of diabetes ranged widely in the different studies included.

In comparison to persons without diabetes, persons with diabetes were at significantly increased risk for developing CHD (adjusted HR = 2.00 (95% CI 1.83, 2.19), ischemic stroke (HR = 1.56; 1.19, 2.05), hemorrhagic stroke (HR = 1.84 (1.59, 2.13) and for other vascular deaths after controlling for a variety of additional demographic and clinical factors. The odds of developing, or dying from, diabetes were higher in women than in men, in middle-aged as compared to elderly individuals, and in those without certain CHD risk factors than in those with these predisposing factors.

In contrast to these findings, fasting concentrations of blood glucose were non-linearly related to the risk of vascular disease after adjusting for several covariates. Impaired glucose tolerance also did not improve estimation of the risk of vascular disease after the inclusion of several conventional risk factors for CHD and other vascular disorders.


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