Highlights
- •Control status of traditional risks differs among glucose abnormality and prior CAD.
- •Prior CAD and DM confer 5- to 8-fold and 2.8-fold subsequent CAD risks, respectively.
- •The impact of borderline glycemia on subsequent CAD was modest.
- •The combination of prior CAD and DM presented a 15-fold increased risk of future CAD.
Abstract
Objective
Although glucose abnormality status (GAS), prior coronary artery disease (CAD), and
other traditional risk factors affect the incidence of subsequent CAD, their impact
in the same cohort has been scantly studied.
Research design and methods
We analyzed data from a nationwide claims database in Japan that was accumulated during
2008–2016 involving 138,162 men aged 18–72 years. Participants were classified as
having normoglycemia, borderline glycemia, or diabetes mellitus (DM) with prior CAD
(CAD+) or without prior CAD (CAD−). Cox regression model identified variables related
to the incidence of CAD.
Results
Among CAD−, management of traditional risks differed from those with and without subsequent
CAD events. On the other hand, such differences were weaker in borderline glycemia
and DM CAD+, and the influence of traditional risk factors on subsequent CAD was not
observed. Cox regression model showed that borderline glycemia and DM confer approximately
1.2- and 2.8-fold excess risks of CAD, respectively, compared with CAD− with normoglycemia.
CAD+ confers approximately a 5- to 8-fold increased risk. The impacts of DM and prior
CAD additively reached a hazard ratio (HR) of 15.74 (95% confidence interval [CI]:
11.82–21.00). However, the HR in those with borderline glycemia and CAD+ was 7.20
(95% CI: 5.01–10.34), which was not different from those with normoglycemia and CAD+.
Conclusion
Control status of traditional risk factors and impact on subsequent CAD differ among
categories of glycemic status with and without prior CAD. Individualizing treatment
strategies is needed in consideration of risk factors, such as GAS and CAD+.
Abbreviations:
CAD (coronary artery disease), HRs (hazard ratios), SBP (systolic blood pressure), DBP (diastolic blood pressure), TG (triglycerides), CABG (coronary artery bypass grafting), PCI (percutaneous coronary intervention)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Metabolism - Clinical and ExperimentalAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Fulcher J, O'Connell R, Voysey M, Emberson J, Blackwell L, Mihaylova B, et al. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet (London, England). 2015;385:1397–405.
- Is diabetes a coronary risk equivalent? Systematic review and meta-analysis.Diabetic medicine: a journal of the British Diabetic Association. 2009; 26: 142-148
- Diabetes and prior coronary heart disease are not necessarily risk equivalent for future coronary heart disease events.J Gen Intern Med. 2016; 31: 387-393
- Diabetes patients requiring glucose-lowering therapy and nondiabetics with a prior myocardial infarction carry the same cardiovascular risk: a population study of 3.3 million people.Circulation. 2008; 117: 1945-1954
Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet (London, England). 2010;375:2215–22.
- New and known type 2 diabetes as coronary heart disease equivalent: results from 7.6 year follow up in a Middle East population.Cardiovasc Diabetol. 2010; 9: 84
- 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
Norhammar A, Lindback J, Ryden L, Wallentin L, Stenestrand U. Improved but still high short- and long-term mortality rates after myocardial infarction in patients with diabetes mellitus: a time-trend report from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admission. Heart (British Cardiac Society). 2007;93:1577–83.
- Management of Hyperglycemia in Type 2 Diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).Diabetes Care. 2018; 41: 2669-2701
International Diabetes Federation. IDF diabetes atlas - 8th edition, https://diabetesatlas.org/;2017 [accessed 16 October 2018].
- Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis.BMJ. 2016; 355: i5953
- Pre-diabetes and the risk for cardiovascular disease: a systematic review of the evidence.J Am Coll Cardiol. 2010; 55: 1310-1317
Qiu M, Shen W, Song X, Ju L, Tong W, Wang H, et al. Effects of prediabetes mellitus alone or plus hypertension on subsequent occurrence of cardiovascular disease and diabetes mellitus: longitudinal study. Hypertension (Dallas, Tex: 1979). 2015;65:525–30.
- Impact of body mass index and metabolic phenotypes on coronary artery disease according to glucose tolerance status.Diabetes Metab. 2017; 43: 543-546
- Development of a database of health insurance claims: standardization of disease classifications and anonymous record linkage.J Epidemiol. 2010; 20: 413-419
- Impact of glucose tolerance status on the development of coronary artery disease among working-age men.Diabetes Metab. 2017; 43: 261-264
Harada M, Fujihara K, Osawa T, Yamamoto M, Kaneko M, Ishizawa M, et al. Association of treatment-achieved HbA1c with incidence of coronary artery disease and severe eye disease in diabetes patients. Diabetes & metabolism. 2018; pii: S1262–3636(18)30167–8. doi: https://doi.org/10.1016/j.diabet.2018.08.009.
Harada M, Fujihara K, Osawa T, Yamamoto M, Kaneko M, Kitazawa M, et al. Relationship between number of multiple risk factors and coronary artery disease risk with and without diabetes mellitus. The Journal of Clinical Endocrinology and Metabolism. 2019; pii: 5469228. doi: https://doi.org/10.1210/jc.2019-00168.
- Higher pulse pressure predicts initiation of dialysis in Japanese patients with diabetes.Diabetes Metab Res Rev. 2019; 35e3120
- Lifestyle and cardiovascular disease in Japan.J Atheroscler Thromb. 2011; 18: 83-88
- Risks for cardiovascular disease, stroke, ischaemic heart disease, and diabetes mellitus associated with the metabolic syndrome using the new harmonised definition: findings from nationally representative longitudinal data from an Asian population.Atherosclerosis. 2010; 213: 579-585
- Cardiovascular disease and risk factors in Asia: a selected review.Circulation. 2008; 118: 2702-2709
- Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial.The Lancet Diabetes & Endocrinology. 2017; 5: 951-964
- Improved trends in cardiovascular complications among subjects with type 2 diabetes in Korea: a nationwide study (2006–2013).Cardiovasc Diabetol. 2017; 16: 1
- Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes.N Engl J Med. 2015; 373: 2117-2128
- Liraglutide and cardiovascular outcomes in type 2 diabetes.N Engl J Med. 2016; 375: 311-322
- Canagliflozin and cardiovascular and renal events in type 2 diabetes.N Engl J Med. 2017; 377: 644-657
- Secondary prevention of cardiovascular disease in type 2 diabetes and prediabetes: a cardiologist's perspective.Int J Clin Pract. 2008; 62: 287-299
- Effect of nateglinide on the incidence of diabetes and cardiovascular events.N Engl J Med. 2010; 362: 1463-1476
- Effect of intensive versus standard blood pressure treatment according to baseline prediabetes status: a post hoc analysis of a randomized trial.Diabetes Care. 2017; 40: 1401-1408
- Prediabetes and risk for cardiac death among patients with coronary artery disease: the ARTEMIS study.Diabetes Care. 2019; 42: 1319-1325
- Association of prediabetes with diffuse coronary narrowing and small-vessel disease.J Cardiol. 2014; 63: 29-34
- Diabetes mellitus, prediabetes, and incidence of subclinical myocardial damage.Circulation. 2014; 130: 1374-1382
- Non-culprit plaque characteristics in acute coronary syndrome patients with raised hemoglobinA1c: an intravascular optical coherence tomography study.Cardiovasc Diabetol. 2018; 17: 90
- Residual risk factors to predict major adverse cardiovascular events in atherosclerotic cardiovascular disease patients with and without diabetes mellitus.Sci Rep. 2017; 7: 9179
- Declining trends of diabetic nephropathy, retinopathy and neuropathy with improving diabetes care indicators in Japanese patients with type 2 and type 1 diabetes (JDDM 46).BMJ Open Diabetes Res Care. 2018; 6e000521
- The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010.Diabetes Care. 2013; 36: 2271-2279
- Achievement of treatment goals for secondary prevention of myocardial infarction or stroke in 29,325 patients with type 2 diabetes: a German/Austrian DPV-multicenter analysis.Cardiovasc Diabetol. 2016; 15: 72
- Sex differences in risk factors for myocardial infarction: cohort study of UK Biobank participants.Bmj. 2018; 363: k4247
- Efficacy and safety of drug-eluting stenting compared with bypass grafting in diabetic patients with multivessel and/or left main coronary artery disease.Sci Rep. 2019; 9: 7268
Article info
Publication history
Published online: October 27, 2019
Accepted:
September 21,
2019
Received:
May 29,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
