Mortality from coronary heart disease and cerebrovascular disease and associated risk factors in diabetic patients in Osaka District, Japan

doi:10.1016/0168-8227(94)01018-U

Diabetes Research and Clinical Practice

Volume 27, Issue 1, January 1995, Pages 77-83

https://doi.org/10.1016/0168-8227(94)01018-U Get rights and content

Abstract

Mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD), as well as associated risk factors, were examined. The subjects studied were 1939 non-insulin-dependent diabetic (NIDDM) patients and 503 deaths were observed during a mean follow-up period of 9.4 years. Of these deaths, 62 were CHD deaths and 84 were CVD deaths. The mortality rates per 1000 person-years from CHD were 3.95 for males and 2.57 for females and those from CVD were 5.12 and 3.86 for males and females, respectively, showing a higher mortality for males and an increasing trend with age. The baseline factors associated with CHD mortality were age at entry into the study, hypertension, ischemic ECG changes, serum cholesterol level, diabetic retinopathy and albuminuria, while those associated with CVD were age at entry, hypertension, ischemic ECG changes, diabetic retinopathy, albuminuria and therapeutic regimen, all of which were found to be significant by univariate analysis. The relationships were further analyzed by the multiple logistic method. In addition, the baseline characteristics of the patients who died of CHD and CVD were compared with those of patients who died from other causes. The baseline characteristics in cases of deaths from CHD and CVD were significantly different from those of deaths from other causes in terms of obesity, ischemic ECG changes, serum cholesterol level and serum triglycerides level for deaths from CHD and in terms of age at onset, age at death and hypertension for deaths from CVD.

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Diabetic retinopathy related homeostatic dysregulation and its association with mortality among diabetes patients: A cohort study from NHANES
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To develop a metric termed the diabetic retinopathy-related homeostatic dysregulation (DRHD) value, and estimate its association with future risk of mortality in individuals with type 2 diabetes.
With the data of the NHANES, the biomarkers associated with DR were identified from 40 clinical parameters using LASSO regression. Subsequently, the DRHD value was constructed utilizing the Mahalanobis distance approach. In the retrospective cohort of 6420 type 2 diabetes patients, we estimated the associations between DRHD values and mortality related to all-cause, cardiovascular disease (CVD) and diabetes-specific causes using Cox proportional hazards regression models.
A set of 14 biomarkers associated with DR was identified for the construction of DRHD value. During an average of 8 years of follow-up, the multivariable-adjusted HRs and corresponding 95 % CIs for the highest quartiles of DRHD values were 2.04 (1.76, 2.37), 2.32 (1.78, 3.01), and 2.29 (1.72, 3.04) for all-cause, CVD and diabetes-specific mortality, respectively. Furthermore, we developed a web-based calculator for the DRHD value to enhance its accessibility and usability (https://dzwxl-drhd.streamlit.app/).
Our study constructed the DRHD value as a measure to assess homeostatic dysregulation among individuals with type 2 diabetes. The DRHD values exhibited potential as a prognostic indicator for retinopathy and for mortality in patients affected by type 2 diabetes.
Severity of Diabetic Retinopathy and the Risk of Future Cerebrovascular Disease, Cardiovascular Disease, and All-Cause Mortality
2021, Ophthalmology
To determine the relationship between the severity of diabetic retinopathy and the future risk of cerebrovascular accident (CVA), myocardial infarction (MI), congestive heart failure (CHF), and all-cause mortality in patients with type 2 diabetes mellitus.
Retrospective cohort study.
Patients with type 2 diabetes who underwent diabetic retinopathy screening via fundus photography.
The relationship between retinopathy status and the 5-year risk of first-time CVA, MI, CHF, and all-cause mortality was investigated using multivariate Cox proportional hazards regressions that controlled for age, gender, race or ethnicity, hemoglobin A1c, duration of diabetes, high-density lipoprotein level, low-density lipoprotein level, history of hypertension, systolic blood pressure, diastolic blood pressure, tobacco use, statin use, body mass index, urine microalbumin-to-creatinine ratio, and estimated glomerular filtration rate.
Five-year risk of first-time CVA, MI, CHF, and all-cause mortality.
Seventy-seven thousand three hundred seventy-six patients were included in this study. The average age was 59.8 years with 53.6% male, 31.2% non-Hispanic White, and 41.4% Hispanic patients. Diabetic retinopathy was significantly associated with all outcomes on multivariate analysis. Compared with patients with no retinopathy, those with minimal nonproliferative diabetic retinopathy (NPDR) had a higher risk of CVA (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.18–1.46), MI (HR, 1.30; 95% CI, 1.15–1.46), CHF (HR, 1.29; 95% CI, 1.19–1.40), and death (HR, 1.15; 95% CI, 1.05–1.25). Similarly, patients with moderate to severe NPDR had a higher risk of each outcome (CVA: HR, 1.56; 95% CI, 1.29–1.89; MI: HR, 1.92; 95% CI, 1.57–2.34; CHF: HR, 1.90; 95% CI, 1.66–2.18, and death: HR, 1.55; 95% CI, 1.32–1.82), as did patients with proliferative diabetic retinopathy (CVA: HR, 2.53; 95% CI, 1.84–3.48; MI: HR, 1.89; 95% CI, 1.26–2.83; CHF: HR, 1.96; 95% CI, 1.47–2.59; and death: HR, 1.87; 95% CI, 1.36–2.56).
Diabetic retinopathy is significantly associated with future risk of CVA, MI, CHF, and death, with higher degrees of retinopathy appearing to carry a heightened risk for each outcome. Retinal information may provide valuable insights into patients’ risk of future vascular disease and death.
Prospective Association between Diabetic Retinopathy and Cardiovascular Disease - A Systematic Review and Meta-analysis of Cohort Studies
2016, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
However, the findings were not consistent across reports. One study in Japan with 1636 T2DM patients found no significant association between DR and coronary heart disease (CHD) mortality after a mean follow-up period of 9.4 years (relative risk [RR]: 1.36, 95% confidence interval [CI]: .81-2.26).9 In contrast, another study conducted in Japan showed that the RR of developing CV disease in T2DM patients was 4.41 (95% CI: 1.81-10.75) compared to those without DR.10 Therefore, in the present study, we performed a systematic review and meta-analysis to investigate the association between DR and CV disease in cohort studies using subgroup analysis according to diabetes types.
Diabetic retinopathy (DR) is linked to increased risk of cardiovascular (CV) disease. However, the effect size of the association was not consistent. In this study, we performed a systematic review and meta-analysis of available cohort studies to determine the association between DR and CV disease, and to investigate the factors that influence the association.
Terms related to DR and CV disease were searched from MEDLINE and EMBASE database. High-quality articles (Newcastle–Ottawa scales above 6) conducted in cohort studies reporting the association between DR and CV disease were identified. Study-specific estimates were pooled using random effects with inverse variance meta-analysis. Subgroup analysis was performed according to diabetes types. Heterogeneity of included studies was assessed using the I² test. The cause of the heterogeneity was examined using metaregression analyses.
A total of 13 studies representing 17,611 patients without CV disease at baseline were included. At follow-up, there were 1457 CV disease-related incidences. Overall, DR was associated with increased risk of CV disease (relative risk [RR]: 2.42, 95% confidence interval [CI]: 1.77-3.31) in diabetes. Specifically, the RR was 3.59 (95% CI: 1.79-7.20) for type 1 diabetes and 1.81 (95% CI: 1.47-2.23) for type 2 diabetes. Significant heterogeneity was found in studies with type 1 diabetes. Metaregression analysis showed that baseline systolic blood pressure was a key factor leading to the heterogeneity.
In conclusion, DR is significantly associated with CV disease incidence and CV disease-related mortality in diabetes. Patients with DR may need more intensive management to control future CV disease attacks.
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Diabetes mellitus is among the most prevalent diseases with which a large population of world is suffering from. Incidence of diabetes is on rise all over the world. Hence management of diabetes and related complications is of prime importance. Finding of new drugs and betterment of current therapeutic regimen is necessary to achieve the target of decreasing the mortalities and morbidities related with the diabetes and its complications. Plants have served as a great source of medicines for variety of diseases and aliments including diabetes and its complications. Various groups of phytochemicals derived from plant are identified and reported to have antidiabetic activity along with having potential to treat complications of it. In this chapter we have discussed flavonoid and its different subclasses in context with their antidiabetic activity along with their potential in management and treatment of diabetic complications.
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Citation Excerpt :
The European Prospective Investigation into Cancer in Norfolk population study showed that risk of stroke appeared to increase with even high normal levels of urine albumin.22 Later meta-analyses showed robust relationships between overt proteinuria and stroke risk as well as a nearly two-fold increased risk of incident stroke among individuals with a urine albumin to creatinine ratio (UACR) between 30 and 300 mg/g as compared with individuals with a UACR in the normal range (Fig. 2).23-34 Even higher stroke risk was seen among people with a UACR of 300 mg/g or higher.35
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Citation Excerpt :
Two studies5,19 reported the effects of macroalbuminuria compared with normal levels of albuminuria, whereas the remaining 8 studies reported an estimate of risk associated with overt proteinuria compared with no overt proteinuria. Eight studies5-11,19 provided an estimate of the effect of the association between proteinuria and stroke that was adjusted for major cardiovascular risk factors, including blood pressure, smoking, diabetes, and total cholesterol level, whereas the remaining 2 studies provided estimates that were adjusted for only age and sex (Table 2). Overall, proteinuria was associated with a 71% (95% CI, 1.39 to 2.10) greater risk of stroke (Fig 2), with evidence of significant heterogeneity in the magnitude of the association across studies (I2 = 60%; P for heterogeneity = 0.008).
The associations between decreased kidney function and cardiovascular disease recently have been established. However, there is uncertainty about the consistency between the independent associations of proteinuria as a risk factor across all cardiovascular end points. We undertook a meta-analysis of published cohort studies to provide a reliable estimate of the strength of association between proteinuria and risk of stroke.
Meta-analysis of observational cohort studies.
General population of participants with diabetes. Studies were excluded if participants had known glomerular disease or had undergone dialysis or transplantation.
MEDLINE, EMBASE, and CINAHL databases were searched for studies that reported age- or multivariate-adjusted risk ratio with some estimate of the variance of the association between proteinuria and risk of stroke, without language restriction.
Proteinuria or albuminuria.
Fatal or nonfatal stroke.
Data from 10 published studies involving 140,231 participants and 3,266 strokes were eligible for inclusion. Participants with proteinuria had a 71% greater risk of stroke compared with those without proteinuria (95% confidence interval, 1.39 to 2.10). There was evidence of significant quantitative heterogeneity in the magnitude of the association across studies (I² = 60%; P for heterogeneity = 0.008), which was partially explained by differences in methods for measuring proteinuria. The risk of stroke remained significant after adjustment for other vascular risk factors.
Because individual patient data were unavailable, we were unable to fully examine the impact of adjustment for known cardiovascular risk factors on the strength of the association between proteinuria and stroke risk. It is possible that the pooled estimate was affected by regression dilution bias.
These findings support the independent relationship between proteinuria and stroke. Additional studies are warranted to determine whether interventions to reduce proteinuria are effective at reducing rates of stroke.

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Mortality from coronary heart disease and cerebrovascular disease and associated risk factors in diabetic patients in Osaka District, Japan

Abstract

Japan. Diabetes Res. Clin. Pract.

Lancet

Diabetes and macroangiopathy — present situation in Japan

Surveys on causes of death among diabetic patients in MIN-I-REN, a group of hospitals and clinics — a profile of the last 15 years

J. Jpn. Diab. Soc.

Mortality and causes of death among Japanese diabetics: factors presented at entry influencing the prognosis — a prospective five-year follow-up study

J. Jpn. Diab. Soc.

A long-term follow-up study of Japanese diabetic patients: mortality and causes of death

Diabetologia

Risk factors for coronary heart disease in diabetes mellitus

Diabetes

Predisposition to atherosclerosis in the head, heart and legs. The Framingham Study

J. Am. Med. Assoc.

Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentrations

Diabetes Care

The Bedford Study: Ten year mortality rates in newly diagnosed diabetics, borderline diabetics and normoglycemic controls and risk indices for coronary heart disease in borderline diabetics

Diabetologia