Screen-detected diabetes, hypertension and hypercholesterolemia as predictors of cardiovascular mortality in five populations of Asian origin: the DECODA study.
BACKGROUND
The World Health Organization (WHO) predicts that the Asia Pacific region will experience an increase in cardiovascular disease (CVD) as a result of demographic changes and an increasing prevalence of diabetes. The aims of this study were to assess the predictive value of glucose tolerance status as a risk factor for CVD and identify a high-risk group for fatal CVD in population-based studies of Asians.


METHODS
A meta-analysis of five prospective cohort studies of Japanese and Asian Indian origin from five countries.


METHODS
A total of 6573 subjects without a history of CVD from five prospective studies were followed for 5-10 years. Diabetes at baseline was diagnosed according to 1999 WHO criteria. Hazard ratios for death from CVD were estimated using a Cox proportional hazard model, adjusting for glucose tolerance status together with established risk factors for CVD.


RESULTS
The meta-analysis showed that the overall hazard ratios (95% confidence interval) for CVD mortality corresponding to the presence of screen-detected diabetes, hypertension and hypercholesteremia were 3.42 (2.23-5.23), 1.57 (1.10-2.24) and 1.49 (1.05-2.10), respectively. Stratified multivariate analysis of the pooled data showed that subjects with screen-detected diabetes in the presence of hypertension or hypercholesteremia had the highest risk of CVD in individuals without previous CVD or diabetes. Subjects with screen-detected diabetes in the presence of hypertension or hypercholesteremia comprised 78% of CVD deaths that occurred in all subjects with screen-detected diabetes.


CONCLUSIONS
The early detection of undiagnosed diabetes in hypertension or hypercholesteremia may have clinical and public health implications for the primary prevention of rapidly increasing diabetes-related atherosclerotic CVD in Asian populations.
Nakagami
Tomoko
T
Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan. nakagami@dmc.twnu.ac.jp
Qiao
Qing
Q
Tuomilehto
Jaakko
J
Balkau
Beverley
B
Tajima
Naoko
N
Hu
Gang
G
Borch-Johnsen
Knut
K
D001208:Asia / Q000453:epidemiology; D044466:Asian People; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis / Q000401:mortality*; D006973:Hypertension / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D015996:Survival Rate