Differences in risk factors for coronary heart disease among diabetic and nondiabetic individuals from a population with high rates of diabetes: the Strong Heart Study.
BACKGROUND
Coronary heart disease (CHD) is the leading cause of death in the United States.


OBJECTIVE
This study compares differences in risk factors for CHD in diabetic vs. nondiabetic Strong Heart Study participants.


METHODS
This was an observational study.


METHODS
The study was conducted at three centers in Arizona, Oklahoma, and North and South Dakota.


METHODS
Data were obtained from 3563 of 4549 American Indians free of cardiovascular disease at baseline.


METHODS
CHD events were ascertained during follow-up.


METHODS
CHD events were classified using standardized criteria.


RESULTS
In diabetic and nondiabetic participants, 545 and 216 CHD events, respectively, were ascertained during follow-up (21,194 and 22,990 person-years); age- and sex-adjusted incidence rates of CHD were higher for the diabetic group (27.5 vs. 12.1 per 1,000 person-years). Risk factors for incident CHD common to both groups included older age, male sex, prehypertension or hypertension, and elevated low-density lipoprotein cholesterol. Risk factors specific to the diabetic group were lower high-density lipoprotein cholesterol, current smoking, macroalbuminuria, lower estimated glomerular filtration rate, use of diabetes medication, and longer duration of diabetes. Higher body mass index was a risk factor only for the nondiabetic group. The association of male sex and CHD was greater in those without diabetes than in those with diabetes.


CONCLUSIONS
In addition to higher incidence rates of CHD events in persons with diabetes compared with those without, the two groups differed in CHD risk factors. These differences must be recognized in estimating CHD risk and managing risk factors.
Center for Biostatistics, The Methodist Hospital Research Institute, 6565 Fannin Street, MGJ 6-032, Houston, Texas 77030, USA. jxu@tmhs.org
Jiaqiong
J
Xu
Elisa T
ET
Lee
Leif E
LE
Peterson
Richard B
RB
Devereux
Everett R
ER
Rhoades
Jason G
JG
Umans
Lyle G
LG
Best
William J
WJ
Howard
Jaya
J
Paranilam
Barbara V
BV
Howard
D000368:Aged; D003327:Coronary Disease / Q000208:ethnology* / Q000401:mortality*; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000401:mortality; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000208:ethnology / Q000401:mortality; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors