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Age, gender, insulin and blood glucose control status alter the risk of ischemic heart disease and stroke among elderly diabetic patients.
- Source :
-
Cardiovascular diabetology [Cardiovasc Diabetol] 2011 Oct 06; Vol. 10, pp. 86. Date of Electronic Publication: 2011 Oct 06. - Publication Year :
- 2011
-
Abstract
- Background: We analyzed the effects of insulin therapy, age and gender on the risk of ischemic heart disease (IHD) and cerebrovascular accident (CVA) according to glycemic control.<br />Methods and Results: We performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study) of type 2 diabetes patients (n = 4014) for 2 years. The primary endpoint was the onset of fatal/non-fatal IHD and/or CVA, which occurred at rates of 7.9 and 7.2 per 1000 person-years, respectively. We divided diabetic patients into four groups based on age (≤ 70 and > 70) and hemoglobin A1C levels (≤ 7.0 and > 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure and low HDL-C in patients under 70 years of age with fair glycemic control and was associated with low diastolic blood pressure in the older/fair group. Interestingly, insulin use was associated with IHD in the older/poor group (OR = 2.27, 95% CI = 1.11-5.89; p = 0.026) and was associated with CVA in the older/fair group (OR = 2.09, 95% CI = 1.06-4.25; p = 0.028). CVA was associated with lower HDL-C and longer duration of diabetes in younger/poor glycemic control group. Results by stepwise analysis were similar. Next, patients were divided into four groups based on gender and diabetic control(hemoglobinA1C < or > 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure in male/fair glycemic control group, age in male/poor control group, and short duration of diabetic history in females in both glycemic control groups. Interestingly, insulin use was associated with IHD in the male/poor group(OR = 4.11, 95% CI = 1.22-8.12; p = 0.018) and with CVA in the female/poor group(OR = 3.26, 95% CI = 1.12-6.24; p = 0.02). CVA was associated with short duration of diabetes in both female groups.<br />Conclusions: IHD and CVA risks are affected by specific factors in diabetics, such as treatment, gender and age. Specifically, insulin use has a potential role in preventing IHD but may also be a risk factor for CVA among the diabetic elderly, thus revealing a need to develop improved treatment strategies for diabetes in elderly patients. The Japan Cholesterol and Diabetes Mellitus Study was formulated to evaluate them(Umin Clinical Trials Registry, clinical trial reg. no. UMIN00000516; http://www.umin.ac.jp/ctr/index.htm).
- Subjects :
- Adult
Age Factors
Aged
Aged, 80 and over
Blood Glucose drug effects
Cohort Studies
Diabetes Mellitus, Type 2 drug therapy
Female
Follow-Up Studies
Humans
Insulin therapeutic use
Longitudinal Studies
Male
Middle Aged
Myocardial Ischemia chemically induced
Myocardial Ischemia drug therapy
Prospective Studies
Sex Factors
Stroke chemically induced
Stroke drug therapy
Blood Glucose metabolism
Diabetes Mellitus, Type 2 blood
Insulin adverse effects
Myocardial Ischemia blood
Stroke blood
Subjects
Details
- Language :
- English
- ISSN :
- 1475-2840
- Volume :
- 10
- Database :
- MEDLINE
- Journal :
- Cardiovascular diabetology
- Publication Type :
- Academic Journal
- Accession number :
- 21978180
- Full Text :
- https://doi.org/10.1186/1475-2840-10-86