Increased cardiovascular risk associated with diabetes in Dallas County.
BACKGROUND
Diabetes mellitus is a major public health problem in the United States. We assess the prevalence of diabetes in Dallas County, quantify the association between diabetes and subclinical cardiovascular disease, and assess the use of evidence-based cardiovascular disease risk-modifying therapies.


METHODS
This study uses data from 3392 participants aged 30 to 65 years from the Dallas Heart Study, a probability-based, multiethnic sample of residents living in Dallas County, Texas. Three primary outcomes were examined: (1) diabetes prevalence, (2) adjusted odds ratios for detectable coronary calcium stratified by diabetes diagnosis status, and (3) rates of use of evidence-based cardiovascular disease risk-modifying therapies among subjects with diabetes stratified by diabetes diagnosis status.


RESULTS
The estimated prevalence of diabetes in Dallas County was 7.8%, with >40% of diabetic patients undiagnosed before participation in the Dallas Heart Study. Both previously diagnosed and previously undiagnosed diabetes were independently associated with the presence of coronary artery calcium (diagnosed: OR 3.55, 95% CI 1.56-8.05) (undiagnosed: OR 2.98, 95% CI 1.39-6.39). The rates of use of aspirin, angiotensin-converting enzyme inhibitors, and statins were suboptimal, and blood pressure and low-density lipoprotein cholesterol targets were rarely met, especially among subjects with previously undiagnosed diabetes.


CONCLUSIONS
Diabetes is prevalent and is associated with subclinical cardiovascular disease; this association is present even at the time of diagnosis. Despite the cardiovascular risk associated with diabetes, evidence-based risk-modifying therapies continue to be underused, and therapeutic targets remain unmet, especially among people unaware of their diabetes diagnosis.
Das
Sandeep R
SR
Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX 75235-9047, USA.
Vaeth
Patrice A C
PA
Stanek
Harold G
HG
de Lemos
James A
JA
Dobbins
Robert L
RL
McGuire
Darren K
DK
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D002118:Calcium / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000209:etiology*; D015331:Cohort Studies; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000378:metabolism; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015995:Prevalence; D018570:Risk Assessment; D013781:Texas / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
D000806:Angiotensin-Converting Enzyme Inhibitors; D001786:Blood Glucose; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin; D002118:Calcium