title: Age, gender, insulin and blood glucose control status alter the risk of ischemic heart disease and stroke among elderly diabetic patients.
abstract: BACKGROUND
  We analyzed the effects of insulin therapy, age and gender on the risk of ischemic heart disease (IHD) and cerebrovascular accident (CVA) according to glycemic control.
  
  
  RESULTS
  We performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study) of type 2 diabetes patients (n = 4014) for 2 years. The primary endpoint was the onset of fatal/non-fatal IHD and/or CVA, which occurred at rates of 7.9 and 7.2 per 1000 person-years, respectively. We divided diabetic patients into four groups based on age (≤ 70 and > 70) and hemoglobin A1C levels (≤ 7.0 and > 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure and low HDL-C in patients under 70 years of age with fair glycemic control and was associated with low diastolic blood pressure in the older/fair group. Interestingly, insulin use was associated with IHD in the older/poor group (OR = 2.27, 95% CI = 1.11-5.89; p = 0.026) and was associated with CVA in the older/fair group (OR = 2.09, 95% CI = 1.06-4.25; p = 0.028). CVA was associated with lower HDL-C and longer duration of diabetes in younger/poor glycemic control group. Results by stepwise analysis were similar. Next, patients were divided into four groups based on gender and diabetic control(hemoglobinA1C < or > 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure in male/fair glycemic control group, age in male/poor control group, and short duration of diabetic history in females in both glycemic control groups. Interestingly, insulin use was associated with IHD in the male/poor group(OR = 4.11, 95% CI = 1.22-8.12; p = 0.018) and with CVA in the female/poor group(OR = 3.26, 95% CI = 1.12-6.24; p = 0.02). CVA was associated with short duration of diabetes in both female groups.
  
  
  CONCLUSIONS
  IHD and CVA risks are affected by specific factors in diabetics, such as treatment, gender and age. Specifically, insulin use has a potential role in preventing IHD but may also be a risk factor for CVA among the diabetic elderly, thus revealing a need to develop improved treatment strategies for diabetes in elderly patients. The Japan Cholesterol and Diabetes Mellitus Study was formulated to evaluate them(Umin Clinical Trials Registry, clinical trial reg. no. UMIN00000516; http://www.umin.ac.jp/ctr/index.htm).
authors: Department of Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan. hayashi@med.nagoya-u.ac.jp
authors: Toshio
authors: T
authors: Hayashi
authors: Seinosuke
authors: S
authors: Kawashima
authors: Hideki
authors: H
authors: Nomura
authors: Hideki
authors: H
authors: Itoh
authors: Hiroshi
authors: H
authors: Watanabe
authors: Takashi
authors: T
authors: Ohrui
authors: Koutaro
authors: K
authors: Yokote
authors: Hirohito
authors: H
authors: Sone
authors: Yoshiyuki
authors: Y
authors: Hattori
authors: Masao
authors: M
authors: Yoshizumi
authors: Koichiro
authors: K
authors: Ina
authors: Kiyoshi
authors: K
authors: Kubota
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000139:chemically induced / Q000188:drug therapy; D011446:Prospective Studies; D012737:Sex Factors; D020521:Stroke / Q000097:blood* / Q000139:chemically induced / Q000188:drug therapy
chemical_list: D001786:Blood Glucose; D007328:Insulin