Elevated
Risk of CVD Prior to Diagnosis of Type 2 Diabetes
Aggressive
management of cardiovascular risk factors is warranted in
individuals at increased risk for diabetes.
The
object of the study was to examine whether the risk of cardiovascular
disease (CVD) is elevated before clinical diagnosis of type
2 diabetes in women.
The
study uses a total of 117,629 female nurses aged 30–55
years who were free of diagnosed CVD at baseline were
recruited in 1976 and followed for 20 years.
The
results showed a
total of 1,508 women had diagnosed type 2 diabetes at
baseline in 1976. During 20 years of follow-up, 110,227 women remained
free of diabetes diagnosis and 5,894 women developed type 2
diabetes. During 2.2 million person-years of follow-up, we
documented 1,556 new cases of myocardial infarction (MI), 1,405
strokes, 815 fatal coronary heart disease (CHD), and 300 fatal
strokes. Among women who developed type 2 diabetes during follow-up,
the age-adjusted RRs of MI were 3.75 (95% CI 3.10–4.53) for
the period before the diagnosis and 4.57 (3.87–5.39) for
the period after the diagnosis, compared with women who remained
free of diabetes diagnosis. The multivariate RRs further adjusting
for BMI, smoking, and other cardiovascular risk factors were
3.17 (2.61–3.85) and 3.97 (3.35–4.71). The risk of
stroke was also significantly elevated before diagnosis of
diabetes (multivariate RR = 2.30 [1.76–2.99]). Further adjustment
for history of hypertension or hypercholesterolemia did not
appreciably alter the results.
In
conclusion the
data indicated a substantially elevated risk of CVD before
clinical diagnosis of type 2 diabetes in women. These
findings suggest that aggressive management of cardiovascular
risk factors is warranted in individuals at increased risk
for diabetes. Diabetes
Care 25:1129-1134,
