Diabetes, diabetes severity, and coronary heart disease risk equivalence: REasons for Geographic and Racial Differences in Stroke (REGARDS).
BACKGROUND
Evidence is mixed regarding whether diabetes confers equivalent risk of coronary heart disease (CHD) as prevalent CHD. We investigated whether diabetes and severe diabetes are CHD risk equivalents.


METHODS
At baseline, participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (black and white US adults ≥45 years old recruited in 2003-2007) were categorized as having prevalent CHD only (self-reported or electrocardiogram evidence; n = 3,043), diabetes only (self-reported or elevated glucose; n = 4,012), diabetes and prevalent CHD (n = 1,529), and neither diabetes nor prevalent CHD (n = 17,155). Participants with diabetes using insulin and/or with albuminuria (urinary albumin-to-creatinine ratio ≥30 mg/g) were categorized as having severe diabetes. Participants were followed up through 2011 for CHD events (myocardial infarction or fatal CHD).


RESULTS
During a mean follow-up of 5 years, 1,385 CHD events occurred. The hazard ratios of CHD events comparing participants with diabetes only, diabetes, and prevalent CHD and neither diabetes nor prevalent CHD with those with prevalent CHD were 0.65 (95% CI 0.54-0.77), 1.54 (95% CI 1.30-1.83), and 0.41 (95% CI 0.35-0.47), respectively, after adjustment for demographics and risk factors. Compared with participants with prevalent CHD, the hazard ratio of CHD events for participants with severe diabetes was 0.88 (95% CI 0.72-1.09).


CONCLUSIONS
Participants with diabetes had lower risk of CHD events than did those with prevalent CHD. However, participants with severe diabetes had similar risk to those with prevalent CHD. Diabetes severity may need consideration when deciding whether diabetes is a CHD risk equivalent.
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
Favel L
FL
Mondesir
Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Todd M
TM
Brown
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
Paul
P
Muntner
Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Raegan W
RW
Durant
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
April P
AP
Carson
Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL; General Internal Medicine, Weill Cornell Medicine, New York, NY.
Monika M
MM
Safford
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL. Electronic address: elevitan@uab.edu.
Emily B
EB
Levitan
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology*; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
D007004:Hypoglycemic Agents; D007328:Insulin