title: Diabetes and Clinical and Subclinical CVD.
abstract: Diabetes mellitus is a major cardiovascular risk factor and its prevalence has been increasing globally. This review examines the contributions of the MESA (Multi-Ethnic Study of Atherosclerosis), a diverse American cohort (6,814 adults ages 45 to 84, recruited from 2000 to 2002, 50% female, 62% nonwhite) toward understanding the relationship between diabetes and clinical and subclinical cardiovascular disease. People with diabetes have a high burden of subclinical vascular disease as measured by coronary artery calcification (CAC), carotid artery intima-media thickness, valvular calcification, and alterations in left ventricular structure. CAC substantially improves cardiovascular risk prediction. Among adults with diabetes, 63% had CAC >0; above CAC >400 Agatston units the event rate was 4% annually, whereas an absence of CAC was a marker of a very low cardiovascular disease rate (0.4% to 0.1% annually). These stark differences in rates may have implications for screening and/or targeted prevention efforts based on CAC burden. MESA has also provided insight on diabetes epidemiology.
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: abertoni@wakehealth.edu.
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.affiliation: Department of Medicine, Loyola University Chicago, Maywood, IL, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
authors.affiliation: Division of Cardiology, Department of Medicine, The David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Karol
authors.initials: K
authors.lastname: Watson
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Post
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000453:epidemiology / Q000208:ethnology*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000208:ethnology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000453:epidemiology / Q000208:ethnology; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000453:epidemiology / Q000208:ethnology