Journal of the Chinese Medical Association
Volume 73, Issue 5 , Pages 234-240, May 2010

Diabetes and 15-year Cardiovascular Mortality in a Chinese Population: Differential Impact of Hypertension and Metabolic Syndrome

  • Shao-Yuan Chuang

      Affiliations

    • Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, R.O.C.
    • ,
  • Pai-Feng Hsu

      Affiliations

    • Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Shih-Hsien Sung

      Affiliations

    • Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Pesus Chou

      Affiliations

    • Department of Public Health, National Yang-Ming University, Taipei, Taiwan, R.O.C.
    • ,
  • Chen-Huan Chen

      Affiliations

    • Department of Public Health, National Yang-Ming University, Taipei, Taiwan, R.O.C.
    • Department of Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Chen-Huan Chen, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Received 11 September 2009; accepted 14 April 2010.

Article Outline

Background

It remains unclear if the risk for cardiovascular (CV) mortality in patients with diabetes mellitus (DM) is equivalent to that in patients with a history of cardiac disease in Asian populations. The aims of the present study were to investigate whether or not non-heart disease (HD) DM subjects have a similar risk of CV mortality as HD patients without DM (non-DM HD), and whether or not hypertension (HT) or metabolic syndrome (MS) is a CV mortality marker for diabetic subjects identified from a community-based population.

Methods

We followed 11,058 Chinese people aged ≥ 30 years on Kinmen island for a median of 15.0 years.

Results

The age-, sex- and smoking-adjusted hazard ratios for CV mortality were 3.56 [95% confidence interval (CI): 1.99–6.36] for DM subjects with HD, 1.64 (95% CI: 1.25–2.16) for DM without HD (non-HD DM) subjects, and 1.63 (95% CI: 1.09–2.44) for non-DM HD patients, when compared with subjects without DM and HD. Among the 827 non-HD DM subjects identified at the baseline survey, the age-, sex- and smoking-adjusted hazard ratios for CV mortality were 2.36 (95% CI: 1.30–4.28) for the presence versus absence of HT, and 1.23 (95% CI: 0.65–2.34) for the presence versus absence of MS.

Conclusion

Non-HD DM subjects had a similar risk of CV mortality to non-DM HD subjects in this Chinese population. The presence of HT but not MS substantially increased CV mortality risk in the DM subjects.

Key Words:  cardiovascular mortality , cardiovascular risk equivalent , diabetes mellitus

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Kannel WB , McGee DL . Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study . Diabetes Care . 1979;2:120–126
  2. Bulugahapitiya U , Siyambalapitiya S , Sithole J , Idris I . Is diabetes a coronary risk equivalent?: systematic review and meta-analysis . Diabet Med . 2009;26:142–148
  3. Haffner SM , Lehto S , Ronnemaa T , Pyorala K , Laakso M . Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction . N Engl J Med . 1998;339:229–234
  4. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al  The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report . JAMA . 2003;289:2560–2572
  5. Anonymous  . Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) . JAMA . 2001;285:2486–2497
  6. Evans JM , Wang J , Morris AD . Comparison of cardiovascular risk between patients with type 2 diabetes and those who had had a myocardial infarction: cross sectional and cohort studies . BMJ . 2002;324:939–942
  7. Lotufo PA, Gaziano JM, Chae CU, Ajani UA, Moreno-John G, Buring JE, et al. Diabetes and all-cause and coronary heart disease mortality among US male physicians . Arch Intern Med . 2001;161:242–247
  8. Vaccaro O , Eberly LE , Neaton JD , Yang L , Riccardi G , Stamler J . Impact of diabetes and previous myocardial infarction on long-term survival: 25-year mortality follow-up of primary screenees of the Multiple Risk Factor Intervention Trial . Arch Intern Med . 2004;164:1438–1443
  9. Hu G , Jousilahti P , Qiao Q , Katoh S , Tuomilehto J . Sex differences in cardiovascular and total mortality among diabetic and non-diabetic individuals with or without history of myocardial infarction . Diabetologia . 2005;48:856–861
  10. Chen CH , Lin HC , Kuo HS , Chang MS , Chou P . Epidemiology of hypertension in Kin-Hu, Kinmen . Am J Hypertens . 1995;8:395–403
  11. Chen CH , Lin KC , Tsai ST , Chou P . Different association of hypertension and insulin-related metabolic syndrome between men and women in 8437 nondiabetic Chinese . Am J Hypertens . 2000;13:846–853
  12. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus  . Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus . Diabetes Care . 1997;20:1183–1197
  13. Grundy SM , Brewer HB , Cleeman JI , Smith SC , Lenfant C . Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition . Circulation . 2004;109:433–438
  14. Tan CE , Ma S , Wai D , Chew SK , Tai ES . Can we apply the National Cholesterol Education Program Adult Treatment Panel definition of the metabolic syndrome to Asians? . Diabetes Care . 2004;27:1182–1186
  15. Juutilainen A , Lehto S , Ronnemaa T , Pyorala K , Laakso M . Type 2 diabetes as a “coronary heart disease equivalent”: an 18-year prospective population-based study in Finnish subjects . Diabetes Care . 2005;28:2901–2907
  16. Whiteley L , Padmanabhan S , Hole D , Isles C . Should diabetes be considered a coronary heart disease risk equivalent? Results from 25 years of follow-up in the Renfrew and Paisley survey . Diabetes Care . 2005;28:1588–1593
  17. Ho JE , Paultre F , Mosca L , Women's Pooling Project  . Is diabetes mellitus a cardiovascular disease risk equivalent for fatal stroke in women? Data from the Women's Pooling Project . Stroke . 2003;34:2812–2816
  18. Lee CD , Folsom AR , Pankow JS , Brancati FL , Atherosclerosis Risk in Communities (ARIC) Study Investigators  . Cardiovascular events in diabetic and nondiabetic adults with or without history of myocardial infarction . Circulation . 2004;109:855–860
  19. Simons LA , Simons J . Diabetes and coronary heart disease . N Engl J Med . 1998;339:1714–1715
  20. Hu FB, Stampfer MJ, Solomon CG, Liu S, Willett WC, Speizer FE, et al  The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women: 20 years of follow-up . Arch Intern Med . 2001;161:1717–1723
  21. Cho E , Rimm EB , Stampfer MJ , Willett WC , Hu FB . The impact of diabetes mellitus and prior myocardial infarction on mortality from all causes and from coronary heart disease in men . J Am Coll Cardiol . 2002;40:954–960
  22. Hu G , Jousilahti P , Qiao Q , Peltonen M , Katoh S , Tuomilehto J . The gender-specific impact of diabetes and myocardial infarction at baseline and during follow-up on mortality from all causes and coronary heart disease . J Am Coll Cardiol . 2005;45:1413–1418
  23. Hu G , Jousilahti P , Tuomilehto J . Joint effects of history of hypertension at baseline and type 2 diabetes at baseline and during follow-up on the risk of coronary heart disease . Eur Heart J . 2007;28:3059–3066
  24. Thomas GN , Ho SY , Janus ED , Lam KS , Hedley AJ , Lam TH . The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) prevalence of the metabolic syndrome in a Chinese population . Diabetes Res Clin Pract . 2005;67:251–257
  25. Hsu PF , Chuang SY , Cheng HM , Tsai ST , Chou P , Chen CH . Clinical significance of the metabolic syndrome in the absence of established hypertension and diabetes: a community-based study . Diabetes Res Clin Pract . 2008;79:461–467
  26. Anonymous  . Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus . Diabetes Care . 2003;26(Suppl):S5–S20

PII: S1726-4901(10)70051-4

doi:10.1016/S1726-4901(10)70051-4

Journal of the Chinese Medical Association
Volume 73, Issue 5 , Pages 234-240, May 2010

Article Tools