Contributors to Mortality in High-Risk Diabetic Patients in the Diabetes Heart Study
- Amanda J. Cox1,2,3,
- Fang-Chi Hsu4,
- Barry I. Freedman5,
- David M. Herrington6,
- Michael H. Criqui7,
- J. Jeffrey Carr8 and
- Donald W. Bowden1,2,3⇑
- 1Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC
- 2Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC
- 3Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC
- 4Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
- 5Department of Internal Medicine - Nephrology, Wake Forest School of Medicine, Winston-Salem, NC
- 6Department of Internal Medicine - Cardiology, Wake Forest School of Medicine, Winston-Salem, NC
- 7Department of Family and Preventive Medicine, University of California, San Diego, CA
- 8Department of Radiologic Sciences, Wake Forest School of Medicine, Winston-Salem, NC
- Corresponding author: Donald W. Bowden, .
OBJECTIVE Not all individuals with type 2 diabetes and high coronary artery calcified plaque (CAC) experience the same risk for adverse outcomes. This study examined a subset of high-risk individuals based on CAC >1,000 mg (using a total mass score) and evaluated whether differences in a range of modifiable cardiovascular disease (CVD) risk factors provided further insights into risk for mortality.
RESEARCH DESIGN AND METHODS We assessed contributors to all-cause mortality among 371 European American individuals with type 2 diabetes and CAC >1,000 from the Diabetes Heart Study (DHS) after 8.2 ± 3.0 years (mean ± SD) of follow-up. Differences in known CVD risk factors, including modifiable CVD risk factors, were compared between living (n = 218) and deceased (n = 153) participants. Cox proportional hazards regression models were used to quantify risk for all-cause mortality.
RESULTS Deceased participants had a longer duration of type 2 diabetes (P = 0.02) and reduced use of cholesterol-lowering medications (P = 0.004). Adjusted analyses revealed that vascular calcified plaque scores were associated with increased risk for mortality (hazard ratio 1.31–1.63; 3.89 × 10−5 < P < 0.03). Higher HbA1c, lipids, and C-reactive protein and reduced kidney function also were associated with a 1.1- to 1.5-fold increased risk for mortality (3.45 × 10−6 < P < 0.03) after adjusting for confounding factors.
CONCLUSIONS Even in this high-risk group, vascular calcification and known CVD risk factors provide useful information for ongoing assessment. The use of cholesterol-lowering medication seemed to be protective for mortality.
- Received January 10, 2014.
- Accepted June 1, 2014.
- © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.