title: Metabolic predictors of ischemic heart disease and cerebrovascular attack in elderly diabetic individuals: difference in risk by age.
abstract: BACKGROUND
  High LDL-cholesterol (LDL-C) and glucose levels are risk factors for ischemic heart disease (IHD) in middle-aged diabetic individuals; however, the risk among the elderly, especially the very elderly, is not well known. The aim of this study was to identify factors that predict IHD and cerebrovascular attack (CVA) in the elderly and to investigate their differences by age.
  
  
  METHODS
  We performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study) with 5.5 years of follow-up. A total of 4,014 patients with type 2 diabetes and without previous IHD or CVA (1,936 women; age 67.4 ± 9.5 years, median 70 years; <65 years old, n = 1,261; 65 to 74 years old, n = 1,731; and ≥ 75 years old, n = 1,016) were recruited on a consecutive outpatient basis from 40 hospitals throughout Japan. Lipids, glucose, and other factors related to IHD or CVA risk, such as blood pressure (BP), were investigated using the multivariate Cox hazard model.
  
  
  RESULTS
  One hundred fifty-three cases of IHD and 104 CVAs (7.8 and 5.7/1,000 people per year, respectively) occurred over 5.5 years. Lower HDL-cholesterol (HDL-C) and female gender were correlated with IHD in patients ≥75 years old (hazard ratio (HR):0.629, P < 0.01 and 1.132, P < 0.05, respectively). In contrast, systolic BP (SBP), HbA1C, LDL-C and non-HDL-C were correlated with IHD in subjects <65 years old (P < 0.05), and the LDL-C/HDL-C ratio was correlated with IHD in all subjects. HDL-C was correlated with CVA in patients ≥75 years old (HR: 0.536, P < 0.01). Kaplan-Meier estimator curves showed that IHD occurred more frequently in patients <65 years old in the highest quartile of the LDL-C/HDL-C ratio. In patients ≥75 years old, IHD and CVA were both the most frequent among those with the lowest HDL-C levels.
  
  
  CONCLUSIONS
  IHD and CVA in late elderly diabetic patients were predicted by HDL-C. LDL-C, HbA1C, SBP and non-HDL-C are risk factors for IHD in the non-elderly. The LDL-C/HDL-C ratio may represent the effects of both LDL-C and HDL-C. These age-dependent differences in risk are important for developing individualized strategies to prevent atherosclerotic disease.
  
  
  BACKGROUND
  UMIN-CTR, UMIN00000516.
authors.affiliation: Department of Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Japan. hayashi@med.nagoya-u.ac.jp.
authors.forename: Toshio
authors.initials: T
authors.lastname: Hayashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Araki
authors.forename: Seinosuke
authors.initials: S
authors.lastname: Kawashima
authors.forename: Hirohito
authors.initials: H
authors.lastname: Sone
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Watanabe
authors.forename: Takashi
authors.initials: T
authors.lastname: Ohrui
authors.forename: Koutaro
authors.initials: K
authors.lastname: Yokote
authors.forename: Minoru
authors.initials: M
authors.lastname: Takemoto
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kubota
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Noda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Noto
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ina
authors.forename: Hideki
authors.initials: H
authors.lastname: Nomura
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors