Increased Risk of Type 2 Diabetes From a Family History of Coronary Heart Disease and Type 2 Diabetes
- Edwina H. Yeung, SCM12,
- James S. Pankow, PHD3,
- Brad C. Astor, PHD, MPH124,
- Neil R. Powe, MD, MPH, MBA124,
- Christopher D. Saudek, MD5 and
- W.H. Linda Kao, PHD12
- 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- 2Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- 3Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota
- 4Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
- 5Department of Endocrinology, Johns Hopkins School of Medicine, Baltimore, Maryland
- Address correspondence and reprint requests to Edwina Yeung, ScM, Johns Hopkins University, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument St., 2-604, Baltimore, MD 21205. E-mail: eyeung{at}jhsph.edu
- ARIC, Atherosclerosis Risk in Communities
- CHD, coronary heart disease
- CHD-FRS, CHD family risk score
- CVD, cardiovascular disease
The “common soil” hypothesis (1) suggests that a family history of cardiovascular disease (CVD) increases the risk of type 2 diabetes through the common predispositions of obesity (2–7), hypertension (8), metabolic syndrome (9), and other pathways. While several studies (10–12) have shown that a family history of diabetes can increase cardiovascular risk, including subclinical atherosclerosis (11), no study has examined the converse, which is that familial risk of coronary heart disease (CHD) could influence the risk of type 2 diabetes. To test this hypothesis, we measured the association between the familial risk of CHD using the CHD family risk score (CHD-FRS) and incident type 2 diabetes in the Atherosclerosis Risk in Communities (ARIC) study.
RESEARCH DESIGN AND METHODS—
The ARIC Study is a community-based study, which recruited individuals aged 45–64 years from four sites around the U.S. between 1987 and 1989 (13). Participants without diabetes were followed with three exams at ∼3-year intervals. Data collection methods have been previously recorded (14,15). This study analyzed data for 11,297 participants.
Family history of CHD was analyzed by the CHD-FRS. The CHD-FRS quantifies the composite risk for each participant based on observations of CHD in each family (excluding the participant) adjusted for the risk expected based on each family member’s age and sex with incidences found by the Framingham Heart Study (16). The CHD-FRS was analyzed both as a continuous and as a categorical variable with levels previously defined (14,15) as low (<0.5), moderate (−0.5 to 0.5), and high (≥0.5). A low CHD-FRS translates to having very few occurrences in older age or no occurrences of heart attacks at any age among the parents or siblings of the participant. A moderate CHD-FRS corresponds to a few occurrences of heart attacks among immediate family members. A …
