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Relationship between Type 2 Diabetes and Atherosclerotic Cardiovascular Disease

Jan 11, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Andrew Daoud, PharmD Candidate, Florida A&M University

Investigating the high number of deaths of patients with diabetes from atherosclerotic cardiovascular disease.

The researchers of the study note that there is a correlation between type 2 diabetes and cardiovascular diseases. The study utilizes approximately 160,000 participants in this study to try and identify if the relationship between the two is causal. For the individuals that are suffering from diabetes, cardiovascular diseases remain a major threat to their lives because of the rate at which it causes their deaths. The main diseases that have been noted to be the major contributors to the death of diabetes patients include coronary heart disease, peripheral arterial disease, and ischemic stroke.  The main issue in the article is that it is still unclear on whether there exists a causal effect, or if there are any other risks, which may include genetics, that might be associated with the correlation. The authors note that the existing trial evidence on the correlation is inconclusive and thus cannot be entirely relied on to make conclusions. Most of the studies that have highlighted the issue have based their studies on populations with European ancestry. China presents higher cases of people suffering from hemorrhagic stroke compared to western populations, and thus there is a need to examine the association using this population. The researchers use data from China Kadoorie Biobank in the study to examine the relationship and also compare associations specifically in the European and Chinese populations.

The study population involved the enrollment of 512,713 Chinese adults. The age bracket of this study population was between 30 and 79. There were ten main study areas, half of them consisting of those from urban areas while the other half was made up of rural areas. The information collected included data about the lifestyle of the people, their medical history, as well as current medication, using questionnaires in the process. Various recordings were taken, including the collection of blood samples to understand blood pressure and anthropometry. Some follow-ups were instituted, and this happened annually through the local residential and administrative records. The information obtained from the follow-ups included the deaths that had taken place and even the cause of the deaths.  Diabetes was diagnosed through self-reporting of those people who had been previously affected as well as the checking of the plasma glucose concentration. Considerations for intracerebral hemorrhage and major coronary events were considered in diagnosing CVD. Both observation and genetic analyses were conducted by the researchers using the SAS. This was to assess the heterogeneity between the associations of the European and Chinese populations. 

The results indicated that those individuals with type 2 diabetes were much older, and they were likely to be residents of the urban areas. Adiposity, blood pressure, and higher plasma total cholesterol were noted in this population. It was also prevalent that those who had type 2 diabetes had a family history of CVD or prior CVD. Another observation is that there was a modest genetic correlation between type 2 diabetes and ASCVD among the Chinese populations that were used in the study. The study is key in understanding the association between genetic predisposition to type 2 diabetes as well as the causal relationship that might exist with various diseases such as CBVD, cerebral, and coronary manifestations. There was no direct link between the predisposition of type 2 diabetes and the risk of having ICH. From the study, it is suggestive that there is a relationship between type 2 diabetes and CHD because of the pathway role that it plays towards the development of type 2 diabetes. From observations made through this study, it is easy to note that there are variations with the previous studies that were done on the subject. What makes the study strong is that most of the observations have been made on a single population and also involve a non-European ancestry, which is a factor that has been non-existent before. The general conclusion from the study is that there is a causal relationship between type 2 diabetes and the subclinical ASCVD. It is important to find ways to manage type 2 diabetes as a way of reducing the greater risk of death being caused by ASCVD.

Practice Pearls:

  • There was a modest genetic correlation between type 2 diabetes and ASCVD among the Chinese populations in the study.
  • Those who had type 2 diabetes had a family history of CVD or prior CVD.
  • There is a causal relationship between type 2 diabetes and the sub clinical ASCVD.

Reference for “Relationship between Type 2 Diabetes and Atherosclerotic Cardiovascular Disease”:
Gan, Wei et al. “Genetic Predisposition To Type 2 Diabetes And Risk Of Subclinical
Atherosclerosis And Cardiovascular Diseases Among 160,000 Chinese Adults.” Diabetes 68.11 (2019): 2155-2164. Web. 22 Nov. 2019.

 

Andrew Daoud, PharmD. Candidate of Florida Agricultural & Mechanical University School of Pharmacy

 

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