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© 2001 by the American Diabetes Association, Inc.
Pathophysiology/Complications |
Prevalence of Clinical and Isolated Subclinical Cardiovascular Disease in Older Adults With Glucose Disorders
The Cardiovascular Health Study
1 Division of Endocrinology, Kaiser Permanente of Georgia, and Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia
2 Department of Biostatistics, University of Washington, Seattle, Washington
3 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
4 Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
5 Department of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
6 Department of Cardiology, St. Francis Hospital, Roslyn, New York
7 Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland
8 Department of Radiology, Tufts–New England Medical Center, Boston, Massachusetts
9 Division of Epidemiology and Clinical Applications, National Heart, Lung, Blood Institute, National Institutes of Health, Bethesda, Maryland
OBJECTIVE—Clinical cardiovascular disease (CVD) is highly prevalent among people with diabetes. However, there is little information regarding the prevalence of subclinical CVD and its relation to clinical CVD in diabetes and in the glucose disorders that precede diabetes.
RESEARCH DESIGN AND METHODS—Participants in the Cardiovascular Health Study, aged 
65 years (n = 5,888), underwent vascular and metabolic testing. Individuals with known disease in the coronary, cerebral, or peripheral circulations were considered to have clinical disease. Those without any clinical disease in whom CVD was detected by ultrasonography, electrocardiography, or ankle arm index in any of the three vascular beds were considered to have isolated subclinical disease.
RESULTS—Approximately 30% of the cohort had clinical disease, and 
60% of the remainder had isolated subclinical disease. In those with normal glucose status, isolated subclinical disease made up most of the total CVD. With increasing glucose severity, the proportion of total CVD that was clinical disease increased; 75% of men and 66% of women with normal fasting glucose status had either clinical or subclinical CVD. Among those with known diabetes, the prevalence was 88% (odds ratio [OR] 2.46 for men and 4.22 for women, P < 0.0001). There were intermediate prevalences and ORs for those with impaired fasting glucose status and newly diagnosed diabetes.
CONCLUSIONS—Isolated subclinical CVD is common among older adults. Glucose disorders are associated with an increased prevalence of total CVD and an increased proportion of clinical disease relative to subclinical disease.
Abbreviations: AAI, ankle-arm index • ADA, American Diabetes Association • BP, blood pressure • CBD, cerebrovascular disease • CHS, Cardiovascular Health Study • CVD, cardiovascular disease • ECG, electrocardiogram • IFG, impaired fasting glucose • OR, odds ratio • PAD, peripheral arterial disease • WHO, World Health Organization
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