Skip to main content

Advertisement

SpringerLink
Log in

Cardiovascular risk and all-cause mortality attributable to diabetes: Tehran Lipid and Glucose Study

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Aim: To quantify the burden of cardiovascular diseases (CVD), and all-cause mortality attributable to diabetes. Subjects and methods: Data on an 8.6-yr follow-up of 6331 participants (2741 men), free of CVD at baseline, were analyzed to determine the burden of CVD and all-cause mortality attributable to self-reported and screen-detected diabetes mellitus (SRDM and SDDM, respectively). Risks of events of interest were separately assessed for women and men using Cox-proportional-hazard model. Results: The mean age at baseline was 47 yr with 997 (15.7%) of participants having diabetes (men 14.8%, women 16.5%). SRDM and SDDM prevailed in 9.7% (men 9.2, women 10.2%) and 6.0% of participants (men 5.7, women 6.3%), respectively. During follow up (52,404 person-yr), we observed 447 incident cases of CVD [387 had coronary heart disease (CHD)] and 209 deaths. Among men, participants with SDDM had increased relative hazard for all-cause mortality translated to a population attributable risk fraction (PAF) of 10.1%. Among women, SDDM was associated with CVD and CHD but not with all-cause mortality; so that 9.3% and 8.8% of CVD and CHD events were respectively attributable to the SDDM. If SRDM had been eliminated from the population, the incidences of CVD, CHD, and death would have decreased by 10.5, 9.5, and 17.3% in men; and 22.0, 24.2, and 17.8% in women, respectively. Conclusion: SDDM and SRDM have high PAF for all-cause mortality and CVD. Besides diabetes treatment and prevention, screening to detect undiagnosed diabetes should warrant high priority among the public health strategies to lower the incidence of CVD and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Grundy SM, Benjamin I J, Burke GL, et al; Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 1999, 100: 1134–46.

    Article  CAS  PubMed  Google Scholar 

  2. Woodward M, Zhang X, Barzi F, et al; Asia Pacific Cohort Studies Collaboration. The effects of diabetes on the risks of major cardiovascular diseases and death in the Asia-Pacific region. Diabetes care 2003, 26: 360–6.

    Article  CAS  PubMed  Google Scholar 

  3. DECODE Study Group, the European Diabetes Epidemiology Group. Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med 2001, 161: 397–405.

    Article  Google Scholar 

  4. Hadaegh F, Bozorgmanesh MR, Ghasemi A, Harati H, Saadat N, Azizi F. High prevalence of undiagnosed diabetes and abnormal glucose tolerance in the Iranian urban population: Tehran Lipid and Glucose Study. BMC Public Health 2008, 8: 176.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Hadaegh F, Khalili D, Fahimfar N, Tohidi M, Eskandari F, Azizi F. Glucose intolerance and risk of cardiovascular disease in Iranian men and women: results of the 7.6-year follow-up of the Tehran Lipid and Glucose Study (TLGS). J Endocrinol Invest 2009, 32: 724–30.

    Article  CAS  PubMed  Google Scholar 

  6. Harris Ml. Undiagnosed NIDDM: clinical and public health issues. Diabetes care 1993, 16: 642–52.

    CAS  PubMed  Google Scholar 

  7. Yates T, Davies M, Khunti K. Preventing type 2 diabetes: can we make the evidence work? Postgrad Med J 2009, 85: 475–80.

    Article  CAS  PubMed  Google Scholar 

  8. Ma S, Cutter J, Tan CE, Chew SK, Tai ES. Associations of diabetes mellitus and ethnicity with mortality in a multiethnic Asian population: data from the 1992 Singapore National Health Survey. Am J Epidemiol 2003, 158: 543–52.

    Article  PubMed  Google Scholar 

  9. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004, 27: 1047–53.

    Article  PubMed  Google Scholar 

  10. Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world—a growing challenge. N Engl J Med 2007, 356: 213–5.

    Article  CAS  PubMed  Google Scholar 

  11. Safran MA, Vinicor F. The war against diabetes. How will we know if we are winning? Diabetes Care 1999, 22: 508–16.

    Article  CAS  PubMed  Google Scholar 

  12. Heller RF, Dobson AJ, Attia J, Page J. Impact numbers: measures of risk factor impact on the whole population from case-control and cohort: studies. J Epidemiol Community Health 2002, 56: 606–10.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Walter SD. Calculation of attributable risks from epidemiological data. Int J Epidemiol 1978, 7: 175–82.

    Article  CAS  PubMed  Google Scholar 

  14. Benichou J. A review of adjusted estimators of attributable risk. Stat Methods Med Res 2001, 10: 195–216.

    Article  CAS  PubMed  Google Scholar 

  15. Rockhill B, Newman B, Weinberg C. Use and misuse of population attributable fractions. Am J Public Health 1998, 88: 15–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study. JAMA 1979, 241: 2035–8.

    Article  CAS  PubMed  Google Scholar 

  17. Northridge ME. Public health methods—attributable risk as a link between causality and public health action. Am J Public Health 1995, 85: 1202–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Rowe AK, Powell KE, Flanders WD. Why population attributable fractions can sum to more than one. Am J Prev Med 2004, 26: 243–9.

    Article  PubMed  Google Scholar 

  19. Azizi F, Ghanbarian A, Momenan AA, et al. Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II. Trials 2009, 10: 5.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Freedman DS, Kahn HS, Mei Z, et al. Relation of body mass index and waist-to-height ratio to cardiovascular disease risk factors in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 2007, 86: 33–40.

    CAS  PubMed  Google Scholar 

  21. Hadaegh F, Harati H, Ghanbarian A, Azizi F. Association of total cholesterol versus other serum lipid parameters with the short-term prediction of cardiovascular outcomes: Tehran Lipid and Glucose Study. Eur J Cardiovasc Prev Rehabil 2006, 13: 571–7.

    Article  PubMed  Google Scholar 

  22. Gibbons RJ, Abrams J, Chatterjee K, et al; American College of Cardiology; American Heart Association Task Force on Practice Guidelines. Committee on the Management of Patients With Chronic Stable Angina. ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina—Summary Article: A Report of the American College of Cardiology/American Heart: Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 2003, 107: 149–58.

    Article  PubMed  Google Scholar 

  23. Braunwald E, Antman EM, Beasley JW, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). ACC/AHA Guideline Update for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction—2002: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circulation 2002, 106: 1893–900.

    Article  PubMed  Google Scholar 

  24. Genuth S, Alberti KG, Bennett P, et al; Expert: Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes care 2003, 26: 3160–7.

    Article  PubMed  Google Scholar 

  25. Whaley M, Brubaker P, Otto R, Armstrong L (eds). ACSM’s guidelines for exercise testing and prescription. Philadelphia: Lippincott Williams & Wilkins, 2006.

    Google Scholar 

  26. Redberg RF, Benjamin EJ, Bittner V, et al; American Academy of Family Physicians; American Association of Cardiovascular and Pulmonary Rehabilitation; Preventive Cardiovascular Nurses Association. ACCF/AHA 2009 performance measures for primary prevention of cardiovascular disease in adults: a report of the American College of Cardiology Foundation/American Heart: Association task force on performance measures (writing committee to develop performance measures for primary prevention of cardiovascular disease): developed in collaboration with the American Academy of Family Physicians; American Association of Cardiovascular and Pulmonary Rehabilitation; and Preventive Cardiovascular Nurses Association: endorsed by the American College of Preventive Medicine, American College of Sports Medicine, and Society for Women’s Health Research. Circulation 2009, 120: 1296–336.

    Article  PubMed  Google Scholar 

  27. Natarajan S, Lipsitz SR, Rimm E. A simple method of determining confidence intervals for population attributable risk from complex surveys. Stat Med 2007, 26: 3229–39.

    Article  PubMed  Google Scholar 

  28. Altman DG, Bland JM. Statistics Notes: Interaction revisited: the difference between two estimates. BMJ 2003, 326: 219.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Moreira LB, Fuchs SC, Wiehe M, et al. Cardiovascular risk attributable to diabetes in southern Brazil: a population-based cohort study. Diabetes Care 2009, 32: 854–6.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Zhang XH, Lu ZL, Liu L. Coronary heart disease in China. Heart 2008, 94: 1126–31.

    Article  PubMed  Google Scholar 

  31. Fox CS, Coady S, Sorlie PD, et al. Increasing cardiovascular disease burden due to diabetes mellitus: the Framingham Heart Study. Circulation 2007, 115: 1544–50.

    Article  PubMed  Google Scholar 

  32. Dale AC, Nilsen TI, Vatten L, Midthjell K, Wiseth R. Diabetes mellitus and risk of fatal ischaemic heart disease by gender: 1 8 years follow-up of 74 914 individuals in the HUNT 1 Study. Eur Heart J 2007, 28: 2924–9.

    Article  PubMed  Google Scholar 

  33. Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ 2006, 332: 73–8.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Lee WL, Cheung AM, Cape D, Zinman B. Impact of diabetes on coronary artery disease in women and men: a meta-analysis of prospective studies. Diabetes Care 2000, 23: 962–8.

    Article  CAS  PubMed  Google Scholar 

  35. Rockhill B, Newman B, Weinberg C. Use and misuse of population attributable fractions. Am J Public Health 1998, 88: 15–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008, 359: 1577–89.

    Article  CAS  PubMed  Google Scholar 

  37. Wei M, Gaskill SP, Haffner SM, Stern MP. Effects of diabetes and level of glycemia on all-cause and cardiovascular mortality. The San Antonio Heart Study. Diabetes Care 1998, 21: 1167–72.

    Article  CAS  PubMed  Google Scholar 

  38. Hu G; DECODE Study Group. Gender difference in all-cause and cardiovascular mortality related to hyperglycaemia and newly-diagnosed diabetes. Diabetologia 2003, 46: 608–17.

    CAS  PubMed  Google Scholar 

  39. Oba S, Nagata C, Nakamura K, Takatsuka N, Shimizu H. Self-reported diabetes mellitus and risk of mortality from all causes, cardiovascular disease, and cancer in Takayama: a population-based prospective cohort study in Japan. J Epidemiol 2008, 18: 197–203.

    Article  PubMed  Google Scholar 

  40. Saydah SH, Eberhardt MS, Loria CM, Brancati FL. Age and the burden of death attributable to diabetes in the United States. Am J Epidemiol 2002, 156: 714–9.

    Article  PubMed  Google Scholar 

  41. Will JC, Casper M. The contribution of diabetes to early deaths from ischemic heart disease: US gender and racial comparisons. Am J Public Health 1996, 86: 576–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box 19395-4763, Tehran, Iran

    M. Bozorgmanesh, F. Hadaegh MD, F. Sheikholeslami & F. Azizi

Authors
  1. M. Bozorgmanesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Hadaegh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Sheikholeslami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Azizi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Hadaegh MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bozorgmanesh, M., Hadaegh, F., Sheikholeslami, F. et al. Cardiovascular risk and all-cause mortality attributable to diabetes: Tehran Lipid and Glucose Study. J Endocrinol Invest 35, 14–20 (2012). https://doi.org/10.3275/7728

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.3275/7728

Key-words

Search

Navigation