New-Onset Diabetes and Risk of All-Cause and Cardiovascular Mortality
The Cardiovascular Health Study
- Nicholas L. Smith, PHD1,
- Joshua I. Barzilay, MD5,
- Richard Kronmal, PHD2,
- Thomas Lumley, PHD2,
- Daniel Enquobahrie, MD, MPH1 and
- Bruce M. Psaty, MD, PHD134
- 1Department of Epidemiology, University of Washington, Seattle, Washington
- 2Department of Biostatistics, University of Washington, Seattle, Washington
- 3Department of Medicine, University of Washington, Seattle, Washington
- 4Department of Health Services, University of Washington, Seattle, Washington
- 5Kaiser Permanente of Georgia, Tucker, Georgia
- Address correspondence and reprint requests to Nicholas L. Smith, PhD, Cardiovascular Health Research Unit, 1730 Minor Ave., Suite 1360, Seattle, WA 98101. E-mail: nlsmith{at}u.washington.edu
Abstract
OBJECTIVE—Cardiovascular risk associated with new-onset diabetes is not well characterized. We hypothesized that risk of all-cause and cardiovascular mortality would be similar among participants with and without new-onset diabetes in the first years of follow-up and rise over time for new-onset diabetes.
RESEARCH DESIGN AND METHODS—The Cardiovascular Health Study (CHS) is a longitudinal study of cardiovascular risk factors in adults aged ≥65 years. We used CHS participants to define a cohort (n = 282) with new-onset diabetes during 11 years of follow-up. New-onset diabetes was defined by initiation of antidiabetes medication or by fasting plasma glucose >125 mg/dl among CHS participants without diabetes at study entry. Three CHS participants without diabetes were matched for age, sex, and race to each participant with new-onset diabetes at the time of diabetes identification (n = 837). Survival analysis provided adjusted hazard ratios (HRs) for all-cause and cardiovascular mortality.
RESULTS—During a median of 5.9 years of follow-up, there were 352 deaths, of which 41% were cardiovascular. In adjusted analyses, new-onset diabetes was associated with an HR of 1.9 (95% CI 1.4–2.5) for all-cause and 2.2 (1.4–3.4) for cardiovascular mortality compared with no diabetes. Mortality risks were elevated within 2 years of onset, especially cardiovascular risk (4.3 [95% CI 1.7–10.8]), and did not increase over time.
CONCLUSIONS—Our findings indicate that there may be a mortality differential soon after diabetes onset in older adults and suggest that long-term macrovascular damage from atherosclerosis may not be primarily responsible for increased risk.
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted June 8, 2006.
- Received March 15, 2006.
- DIABETES CARE
