© 1998 Oxford University Press
research-article |
Cardiovascular disease in insulin dependent diabetes mellitus: similar rates but different risk factors in the US compared with Europe
aDepartment of Epidemiology, Graduate School of Public Health, University of Pittsburgh Pittsburgh, PA, USA
bDepartment of Epidemiology and Public Health, University College London London, UK
Reprint requests to: TJ Orchard, 5th Floor, Rangos Research Center, 3460 Fifth Avenue, Pittsburgh, PA 15213, USA
BACKGROUND: Cardiovascular disease (CVD) in insulin dependent diabetes mellitus (IDDM) has been linked to renal disease. However, little is known concerning international variation in the correlations with hyperglycaemia and standard CVD risk factors.
METHODS: A cross-sectional comparison was made of prevalence rates and risk factor assodations in two large studies of IDDM subjects: the Pittsburgh Epidemiology of Diabetes Complications Study (EDC) and the EURODIAB IDDM Complications Study from 31 centres in Europe. Subgroups of each were chosen to be comparable by age and duration of diabetes. The EDC population comprises 286 men (mean duration 20.1 years) and 281 women (mean duration 19.9 years); EURODIAB 608 men (mean duration 18.1 years) and 607 women (mean duration 18.9 years). The mean age of both populations was 28 years. Cardiovascular disease was defined by a past medical history of myocardial infarction, angina, and/or the Minnesota ECG codes (1.1–1.3, 4.1–4:3, 5.1–5.3, 7.1).
RESULTS: Overall prevalence of CVD was similar in the two populations (i.e. men 8.6% versus 8.0%, women 7.4% versus 8.5%, EURODIAB versus EDC respectively), although EDC women had a higher prevalence of angina (3.9% versus 0.5%, P < 0.00 1). Multivariate modelling suggests that glycaemic control (HbA1c) is not related to CVD in men. Age and high density lipoprotein cholesterol predict CVD in EURODIAB, while triglycerides and hypertension predict CVD in EDC. For women in both populations, age and hypertension (or renal disease) are independent predictors. HbA1C is also an independent predictor—inversely in EURODIAB women (P < 0.008) and positively in EDC women (P = 0.03). Renal disease was more strongly linked to CVD in EDC than in EURODIAB.
CONCLUSIONS: Despite a similar prevalence of CVD, risk factor associations appear to differ in the two study populations. Glycaemic control (HbA1) does not show a consistent or strong relationship to CVD.
Keywords IDDM, cardiovascular disease, glycaemic control, gender, risk factors
Accepted 6 May 1998
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