Skip to main content
SpringerLink
Log in

Diabetes and modifiable risk factors for cardiovascular disease: the prospective Million Women Study

  • Cardiovascular Disease
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

To compare the effect of potentially modifiable lifestyle factors on the incidence of vascular disease in women with and without diabetes. In 1996–2001 over one million middle-aged women in the UK joined a prospective study, providing medical history, lifestyle and socio-demographic information. All participants were followed for hospital admissions and deaths using electronic record-linkage. Adjusted relative risks (RRs) and incidence rates were calculated to compare the incidence of coronary heart disease and stroke in women with and without diabetes and by lifestyle factors. At recruitment 25,915 women (2.1% of 1,242,338) reported current treatment for diabetes. During a mean follow-up of 6.1 years per woman, 21,928 had a first hospital admission or death from coronary heart disease (RR for women with versus without diabetes = 3.30, 95% CI 3.14–3.47) and 7,087 had a first stroke (RR = 2.47, 95% CI 2.24–2.74). Adjusted incidence rates of these conditions in women with diabetes increased with duration of diabetes, obesity, inactivity and smoking. The 5-year adjusted incidence rates for cardiovascular disease were 4.6 (95% CI 4.4–4.9) per 100 women aged 50–69 in non-smokers with diabetes, 5.9 (95% CI 4.6–7.6) in smokers with diabetes not using insulin and 11.0 (95% CI 8.3–14.7) in smokers with diabetes using insulin. Non-smoking women with diabetes who were not overweight or inactive still had threefold increased rate for coronary disease or stroke compared with women without diabetes. Of the modifiable factors examined in middle aged women with diabetes, smoking causes the greatest increase in cardiovascular disease, especially in those with insulin treated diabetes.

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

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

CHD:

Coronary heart disease

CI:

Confidence interval

CVD:

Cardiovascular disease

RR:

Relative risk

References

  1. Lee WL, Cheung AM, Cape D, Zinman B. Impact of diabetes on coronary artery disease in women and men. Diabetes Care. 2000;23:962–8. doi:10.2337/diacare.23.7.962.

    Article  PubMed  CAS  Google Scholar 

  2. 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. doi:10.2337/diacare.26.2.360.

    Article  Google Scholar 

  3. Adlerberth AM, Rosengren A, Wilhelmsen L. Diabetes and long-term risk of mortality from coronary and other causes in middle-aged Swedish men. Diabetes Care. 1998;21:539–45. doi:10.2337/diacare.21.4.539.

    Article  PubMed  CAS  Google Scholar 

  4. Almdal T, Scharling H, Skov Jensen J, Vestergaard H. The independent effect of Type 2 diabetes mellitus on ischemic heart disease, stroke and death. Arch Intern Med. 2004;164:1422–6. doi:10.1001/archinte.164.13.1422.

    Article  PubMed  Google Scholar 

  5. Barrett-Connor EL, Cohn BA, Wingard DL, Edelstein SL. Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study. JAMA. 1991;265:627–31. doi:10.1001/jama.265.5.627.

    Article  PubMed  CAS  Google Scholar 

  6. Folsom AR, Rasmussen ML, Chambless LE, Howard G, Cooper LS, Shmidt MI, et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. Diabetes Care. 1999;22:1077–83. doi:10.2337/diacare.22.7.1077.

    Article  PubMed  CAS  Google Scholar 

  7. Gu K, Cowie CC, Harris MI. Mortality in adults with and without diabetes in a national cohort of the US population 1971–1993. Diabetes Care. 1998;21:1138–45. doi:10.2337/diacare.21.7.1138.

    Article  PubMed  CAS  Google Scholar 

  8. Hu FB, Stampfer MJ, Solomon CG, Liu S, Willett W, Speizer FE, et al. The impact of diabetes mellitus on mortality from all causes and CHD in women. Arch Intern Med. 2001;161:1717–23. doi:10.1001/archinte.161.14.1717.

    Article  PubMed  CAS  Google Scholar 

  9. Janghorbani M, Hu FB, Willett WC, Li TY, Manson JE, Logroscino G, et al. Prospective study of Type 1 and Type 2 diabetes and risk of stroke subtypes. Diabetes Care. 2007;30:1730–5. doi:10.2337/dc06-2363.

    Article  PubMed  Google Scholar 

  10. Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study. JAMA. 1979;241:2035–8. doi:10.1001/jama.241.19.2035.

    Article  PubMed  CAS  Google Scholar 

  11. Lotufo PA, Gaziano M, Chae CU, Ajani U, Moreno-John G, Buring JE, et al. Diabetes and all-cause and CHD mortality among US male physicians. Arch Intern Med. 2001;161:242–7. doi:10.1001/archinte.161.2.242.

    Article  PubMed  CAS  Google Scholar 

  12. Stamler J, Vaccaro O, Neaton JD, Wentworth D, Multiple Risk Factor Intervention Trial Research Group. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the multiple risk factor intervention trial. Diabetes Care. 1993;16:434–43. doi:10.2337/diacare.16.2.434.

    Article  PubMed  CAS  Google Scholar 

  13. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52. doi:10.1016/S0140-6736(04)17018-9.

    Article  PubMed  Google Scholar 

  14. The Million Women Study Collaborative Group. The Million Women Study: design and characteristics of the study population. Breast Cancer Res. 1999;1:73–80. doi:10.1186/bcr16.

    Article  Google Scholar 

  15. Information and Services Division. Scotland [homepage on the Internet] [cited 14 Jan 2008]. Available from: http://www.isdscotland.org/isd/CCC_FirstPage.jsp.

  16. Hospital Episode Statistics [homepage on the Internet] [cited 14 Jan 2008]. Available from http://www.hesonline.nhs.uk/.

  17. World Health Organization. International Statistical Classification of Diseases and Related Health Problems, vol. 1. Geneva: World Health Organization; 1992.

    Google Scholar 

  18. Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D, et al. Cancer incidence and mortality in relation to BMI in the Million Women Study: cohort study. BMJ. 2007;335:1134–45. doi:10.1136/bmj.39367.495995.AE.

    Article  PubMed  Google Scholar 

  19. Easton DF, Peto J, Babiker AG. Floating absolute risk: an alternative to relative risk in survival and case-control analysis avoiding an arbitrary reference group. Stat Med. 1991;10:1025–35. doi:10.1002/sim.4780100703.

    Article  PubMed  CAS  Google Scholar 

  20. McIntosh A, Hutchinson A, Home PD, Brown F, Bruce A, Damerell A, et al. Clinical guidelines and evidence review for Type 2 diabetes: management of blood glucose. Sheffield: ScHARR, University of Sheffield; 2001.

    Google Scholar 

  21. Banks E, Beral V, Cameron R, Hogg A, Langley N, Barnes I, et al. Agreement between general practice prescription data and self-reported use of hormone replacement therapy and treatment for various illnesses. J Epidemiol Biostat. 2001;6:357–63. doi:10.1080/13595220152601837.

    Article  PubMed  CAS  Google Scholar 

  22. Bush TL, Miller SR, Golden AL, Hale WE. Self-report and medical record agreement of selected medical conditions in the elderly. Am J Public Health. 1989;79:1554–6.

    Article  PubMed  CAS  Google Scholar 

  23. UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53. doi:10.1016/S0140-6736(98)07019-6.

    Article  Google Scholar 

  24. Nathan DM, Cleary PA, Backlund JYC, Genuth SM, Lachin JM, Orchard TJ, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353:2643–53. doi:10.1056/NEJMoa052187.

    Article  PubMed  Google Scholar 

  25. Banks E, Beral V, Cameron R, Hogg A, Langley N, Barnes I, et al. Comparison of various characteristics of women who do and do not attend for breast cancer screening. Breast Cancer Res. 2002;4(1):R1. doi:10.1186/bcr418.

    Article  PubMed  Google Scholar 

  26. The West of Scotland Coronary Prevention Study Group. Computerised record linkage: compared with traditional patient follow-up methods in clinical trials and illustrated in a prospective epidemiological study. J Clin Epidemiol. 1995;48:1441–52. doi:10.1016/0895-4356(95)00530-7.

    Article  Google Scholar 

  27. Kendrick S, Clarke J. The Scottish Record Linkage System. Health Bull (Edinb). 1993;51:72–9.

    CAS  Google Scholar 

  28. Information and Statistics Division NHS Scotland. NHS Scotland Quality Assurance Report on Acute Inpatient/Day case Data 2001–2002, Vol. 2005. Scotland: ISD; 2004.

  29. Liu B, Sweetland S, Beral V, Green J, Balkwill A, Casabonne D. Self-reported information on joint replacement and cholecystectomy agrees well with that in medical records. J Clin Epidemiol. 2007;60:1190–4. doi:10.1016/j.jclinepi.2007.02.007.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the many women who completed questionnaires for this study, staff at the collaborating breast screening units and the Million Women Study coordinating centre and the Information and Statistics Division in Scotland and the Information Centre for Health and Social Care for access to hospital admissions data. The Million Women Study is supported by Cancer Research UK, the Medical Research Council, and the NHS Breast Screening Programme. The researchers act independently of the funders.

Author information

Authors and Affiliations

  1. Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, OX3 7LF, UK

    Elizabeth A. Spencer, Kirstin L. Pirie, Richard J. Stevens, Valerie Beral, Anna Brown, Bette Liu, Jane Green & Gillian K. Reeves

Authors
  1. Elizabeth A. Spencer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kirstin L. Pirie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard J. Stevens
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Valerie Beral
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anna Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bette Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jane Green
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gillian K. Reeves
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Million Women Study Collaborators

Corresponding author

Correspondence to Elizabeth A. Spencer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Spencer, E.A., Pirie, K.L., Stevens, R.J. et al. Diabetes and modifiable risk factors for cardiovascular disease: the prospective Million Women Study. Eur J Epidemiol 23, 793–799 (2008). https://doi.org/10.1007/s10654-008-9298-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-008-9298-3

Keywords

Search

Navigation