Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study

British Medical Journal, March 14, 1998 by R.C. Turner, H. Millns, H.A.W. Neil, I.M. Stratton, S.E. Manley, D.R. Matthews, R.R. Holman

Results

Table 1 shows the baseline risk factors assessed for the 2693 white patients who had no previous indication of disease related to atheroma and had complete data when studied after the initial treatment diet The men who were entered into the United Kingdom prospective diabetes study but excluded from this analysis because of previous cardiovascular disease were older (mean age 56 (SD7) years), had higher systolic blood pressure (mean 141(20) mm Hg), were more likely to be hypertensive (46%), and were more likely to be smokers (10% had never smoked, 51% were ax-smokers, and 39% were current smokers) (P [is less than] 0.01 for each). Women who were excluded from the study were also older (mean age 56 (8) years) and had higher systolic blood pressure (mean 145 (20) mm Hg) (P [is less than] 0.01 for each). Baseline concentrations of total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and triglyceride did not differ in subjects according to the presence of disease related to atheroma (P [is greater than] 0.01).

Table 1 Baseline characteristics in 2693 white patients with no
indication of disease related to atheroma. Results are means (SD)
or geometric mean (1 SD interval) unless stated otherwise

                                   Men               Women
Variable                         (n=1564)           (n=1129)

Age (years)                       52 (9)              53 (9)
Body mass index (kg[m.sup.2])   27.1 (4.7)          29.4 (6.4)
Waist:hip ratio                 0.95 (0.06)         0.87 (0.08)
Systolic blood pressure
 (mm Hg)                         133 (18)            139 (20)
Diastolic blood pressure
 (mm Hg)                          82 (10)             83 (10)
No (%) of patients with
 hypertension                    508 (32)            506 (45)
Fasting plasma glucose
 (mmol/l)                        8.3 (2.8)           9.2 (3.0)
Haemoglobin [A.sub.1c] (%)       6.9 (1.7)           7.4 (1.8)
Total cholesterol (mmol/l)       5.2 (1.0)           5.7 (1.2)
Low density lipoprotein
 cholesterol (mmol/l)            3.3 (0.9)           3.8 (1.1)
High density lipoprotein
 cholesterol (mmol/l)           1.04 (0.23)         1.10 (0.24)
Triglyceride (mmol/l)            1.5 (0.9, 2.4)      1.6 (1.0, 2.6)
Fasting plasma insulin (mU/l)   11.3 (6.6, 19.4)    13.2 (7.7, 22.7)

Exercise (No (%) of subjects)

Sedentary                        261 (17)            251 (22)
Moderate                         496 (32)            440 (39)
Active                           692 (44)            428 (38)
Fit                              115 (7)              10 (1)

Smoking (No (%) of subjects)

Never                            344 (22)            501 (44)
Ex-smoker                        712 (46)            297 (27)
Current                          508 (32)            331 (29)

Haemoglobin [A.sub.1c]--There was an increase in risk of coronary artery disease with haemoglobin [A.sub.1c] of [is greater than] 6.2%, the upper range of normal values, in accord with other studies which suggest that glycaemia above the normal range gives an increased risk for macrovascular disease.[32, 33] If glycation of proteins was a major pathogenic factor for coronary artery disease the increased risk would be expected to be proportional to the degree of hyperglycaemia.[34] The study showed an increased risk of 11% for each increment of 1% in haemoglobin [A.sub.1c], similar to the 10% increase in mortality from ischaemic heart disease for an increment of 1% in haemoglobin [A.sub.1c] reported in Wisconsin.[35]