Impact of body mass index and metabolic phenotypes on coronary artery disease according to glucose tolerance status

ObjectiveThis study aimed to examine the impact of obesity, as defined by body mass index (BMI), and a metabolically unhealthy phenotype on the development of coronary artery disease (CAD) according to glucose tolerance status.MethodsThis population-based retrospective cohort study included 123,746 Japanese men aged 18–72 years (normal glucose tolerance: 72,047; prediabetes: 39,633; diabetes: 12,066). Obesity was defined as a BMI ≥ 25 kg/m². Metabolically unhealthy individuals were defined as those with one or more of the following conditions: hypertension, hypertriglyceridaemia and/or low HDL cholesterol. A Cox proportional hazards regression model identified variables related to CAD incidence.ResultsThe prevalences of obese subjects with normal glucose tolerance, prediabetes and diabetes were 21%, 34% and 53%, whereas those for metabolically unhealthy people were 43%, 60% and 79%, respectively. Multivariate analysis showed that a metabolically unhealthy phenotype increases hazard ratios (HRs) for CAD compared with a metabolically healthy phenotype, regardless of glucose tolerance status (normal glucose tolerance: 1.98, 95% CI: 1.32–2.95; prediabetes: 2.91, 95% CI: 1.85–4.55; diabetes: 1.90, 95% CI: 1.18–3.06). HRs for CAD among metabolically unhealthy non-obese diabetes patients and obese diabetes patients with a metabolically unhealthy status were 6.14 (95% CI: 3.94–9.56) and 7.86 (95% CI: 5.21–11.9), respectively, compared with non-obese subjects with normal glucose tolerance and without a metabolically unhealthy status.ConclusionA metabolically unhealthy state can associate with CAD independently of obesity across all glucose tolerance stages. Clinicians may need to consider those with at least one or more conditions indicating a metabolically unhealthy state as being at high risk for CAD regardless of glucose tolerance status.     

The Effect of Diabetes and Impaired Glucose Tolerance on Mortality in Malta

A random sample of the middle-aged population of Malta was studied in a diabetic survey in 1981. Among the 1537 survey responders, in 659 men and 878 women aged 40 years or more the prevalence of diabetes was 16 % in men and 18 % in women, and that of IGT 5 % in both sexes. By the end of 1985, 90 subjects (49 men: 41 women) had died. Mortality/1000 (95 % CI) was among subjects with normal, impaired glucose tolerance and diabetes in the age group 40–59 years 12 (5–19), 25 (23–73), and 61 (17–148), and in the age group of more than 60 years, 102 (68–136), 148 (59–237), and 178 (122–234), respectively. Age standardized mortality/1000 was in men 51, 28, and 100, and in women 34, 33, and 72 in the three categories of glucose tolerance, respectively. Among diabetic subjects aged 40–64 years the risk of death was increased seven-fold as compared with normoglycaemic subjects. Among men there was an inverse association between body mass index and mortality in all categories of glucose tolerance. Among women, no clear trend between body mass index and mortality was found. The relative risk of death for subjects with diabetes adjusting for age, sex, and body mass index was 2.2 (odds ratio: 95 % CI 1.40 to 3.42) as compared with non-diabetic subjects. The age-adjusted survival curves for normoglycaemic subjects were similar for men and women. Among subjects with abnormal glucose tolerance the survival was slightly better in women than in men (p = 0.056). About half of the deaths were from cardiovascular disease and 7 % from diabetes mellitus.     

Impaired glucose tolerance predicts all-cause mortality among older men at high risk for cardiovascular disease in China

AimsTo investigate the potential association between impaired glucose tolerance (IGT) and all-cause mortality among older men at high risk for cardiovascular disease (CVD) in China.MethodsIn this prospective observational study, 460 older men aged ≥60 years were determined to have either IGT or normal glucose tolerance (NGT) based on an oral glucose tolerance test conducted between May 2005 and May 2007. IGT and NGT were diagnosed according to the 1999 WHO diagnostic criteria. All subjects were followed until March 2017. The primary outcome studied was all-cause mortality. Multivariate Cox models were used to estimate relative risk for all-cause mortality.ResultsDuring a mean follow-up of 11.2 years, forty-three (21.4%) subjects in the IGT group and twenty-nine (11.2%) subjects in the NGT group died (HR 2.05, 95% CI 1.28–3.28, P = 0.003). Multivariate Cox proportional-hazards analysis demonstated that IGT was significantly associated with increased risk for all-cause mortality, composite cardiovascular outcome, nonfatal stroke and heart failure after adjusting for potential confounding factors. Logistic regression analysis showed that IGT at baseline (P < 0.05) rather than incident type 2 diabetes was a risk factor of all-cause mortality.ConclusionsIGT was significantly associated with all-cause mortality in older Chinese men at high risk for CVD.     

Elevated one hour with normal fasting and 2 h plasma glucose helps to identify those at risk for development of Type2 Diabetes-11 years observational study from south India

AimsTo compare conversion rates of diabetes in subjects with elevated 1 h plasma glucose (1hrPG) during an OGTT with normal glucose tolerance(NGT) subjects over a period of 11 years.Methods4023 subjects were selected from electronic data base of medical records.233 subjects who were followed up for a period of 11 years were included.160 with isolated prediabetes and their combinations were excluded.The remaining 73 were categorized into group1 NGT (n = 37) and group-2 (n = 36) with elevated 1hrPG.Kaplan Meier curves for incident diabetes and Cox proportional hazard model were compared between groups.ResultsDuring follow up, 10.8% and 44.4% converted to DM in group1 and group2 (p = 0.003). Elevated 1hrPG was associated with incident diabetes(HR 7.9[95%CI 2.2–28.1](p = 0.001)provided better risk assessment.The adjusted risk of event in subjects with elevated 1hrPG is likely to be 7 times more when compared to NGT.Subjects with elevated1hrPG remained free of diabetes for a median period of 7.6 years (95% CI 5.8–7.8) whereas NGT subjects remained free for 10 years (95% CI 8.5–10.0) (p < 0.001).ConclusionIn conclusion, conversion to DM was higher and risk was 7 times more in subjects with elevated 1hrPG. Elevated 1hrPG during OGTT has to be considered as a distinct entity.     

Ten-year mortality and glucose tolerance status in an elderly Finnish population

The aim of this study was to determine the 10-year mortality rate of an elderly population aged 70 years or over (n=379) with reference to glucose tolerance status, taking into account other determinants of excess mortality. The baseline examination during 1991-1992 included a postal questionnaire, a physical examination and a 2h OGTT, which was classified according to both the 1985 WHO criteria and the 1999 WHO criteria. Follow-up was continued until death or until 31 December 2001. 66% of men and 51% of women died within 10 years. In men, the cumulative mortalities were 84% for previously diagnosed diabetes, 67% for undiagnosed diabetes, 67% for impaired glucose tolerance (IGT) and 60% for normal glucose tolerance (NGT). The corresponding percentages for women were 76, 52, 49, and 40%. Male gender, poor self-rated health and previously diagnosed diabetes were the most powerful predictors of mortality. When adjustments were made for age, gender, BMI, cardiovascular disease, hypertension, physical exercise and self-rated health, the estimated relative mortality rate was 2.0 (95% CI 1.5-2.7) among previously diagnosed diabetic subjects, 1.3 (CI 0.8-2.2) among undiagnosed diabetic subjects and 1.1 (0.8-1.5) among IGT subjects compared to NGT subjects. These relative mortalities were higher in women than in men. When abnormal glucose tolerance was pooled into one category, the OR for excess mortality was 1.4 (95% CI 1.1-1.9).     

Impact of gender on relative rates of cardiovascular events in patients with diabetes

AimTo investigate whether diabetes confers higher relative risks of cardiovascular events in women compared with men using contemporary data and also whether such gender-differences are dependent on age.MethodsAll patients discharged from French hospitals in 2013 with at least 5 years of follow-up and no history of major adverse cardiovascular events including heart failure (MACE-HF; heart failure, myocardial infarction, ischaemic stroke, cardiovascular death) were identified and categorized by diabetes status. Overall and age-stratified incidence rates, hazard ratios (HRs) and women-to-men ratios (WMRs) for MACE-HF leading to hospitalization were also calculated. Adjustments were then made for age and baseline characteristics according to cardiovascular risk factors and non-cardiovascular comorbidities.ResultsThe study included 2,953,816 subjects, among whom 349,928 (11.9%) had diabetes. Of those with diabetes, the absolute rate of MACE-HF was higher in men than in women (96 vs 66 per 1000 person-years); corresponding absolute rates in men and women without diabetes were 44 vs 27 per 1000 person-years. Comparing those with and without diabetes, women had a higher unadjusted HR of MACE-HF (2.45, 95% CI: 2.42–2.47) than men (2.15, 95% CI: 2.14–2.17), with an adjusted WMR of 1.13 (95% CI: 1.12–1.15). HRs of MACE-HF related to diabetes were highest in women aged around 45 years and in the youngest men and decreased with advancing age in both these groups. However, HRs were higher in women of all ages > 40 years. After adjustment, this effect was more apparent for myocardial infarction (adjusted WMR: 1.43, 95% CI: 1.38–1.48) than for either ischaemic stroke (adjusted WMR: 1.10, 95% CI: 1.07–1.14) or heart failure (adjusted WMR: 1.13, 95% CI: 1.11–1.14).ConclusionAlthough men have higher absolute risks of cardiovascular complications, the relative risks of cardiovascular complications associated with diabetes are higher in women than in men.     

The fat-to-lean mass ratio,a novel anthropometric index,is associated to glucose metabolic disorders

ObjectiveThe aim was to evaluate whether the Fat-to-Lean Mass (FyM) ratio is associated to glucose metabolic disorders (GMD).DesignCross-sectional population based study.MethodsEligible subjects were healthy men and non-pregnant women with new diagnosis of GMD that were allocated into following groups: 1) Normal Glucose Tolerance (NGT), 2) Diabetes, 3) impaired fasting glucose (IFG) + impaired glucose tolerance (IGT), 4) IGT, and 5) IFG. The FyM index [Total body fat (Kg)/total lean mass (Kg)], and the odds ratio (OR) between FyM index and GMD were estimated.ResultsA total of 875 individuals with average age 41.62 ± 12.3 were enrolled; of them, 645 (73.1%) women and 230 (22.8%) men; 521 (59.5%), 71 (8.1%), 85 (9.7%), 53 (6.0%), and 145 (16.6%) individuals were allocated into groups with NGT, diabetes, IFG + IGT, IGT, and IFG, respectively. The FyM was significantly associated with prediabetes and diabetes in women (OR 4.2; _95%CI 3.0–11.1 and OR = 7.2; _95%CI 2.0–15.2) and men (OR = 2.6; _95%CI 1.1–6.7 and OR = 4.6; _95%CI 1.4–15.1). In the overall population, the OR between FyM index with IGT, IFG, and IFG + IGT was 8.4 (_95%CI 2.6–17.4), 5.2 (_95%CI 2.6–10.6), and 6.1 (_95%CI 1.8–9.5).ConclusionThe FyM index was strongly associated with all categories of GMD.     

Excess risk of diabetes in persons with hypertension

ProblemPersons with hypertension appear to be at increased risk of diabetes, an important predictor of cardiovascular disease. Whether, and to what extent, this risk may vary across subgroups defined on the basis of important clinical characteristics has not been well characterized.MethodsStudy population included members of Kaiser Permanente Northwest Region, a large health maintenance organization, aged ≥35 years and free of diabetes in 1998. Persons in the study population were stratified based on whether or not they had hypertension, and onset of diabetes was ascertained over a 6-year period beginning January 1999. Excess risk of diabetes was characterized in terms of risk differences between persons with and without hypertension, and was estimated on an overall basis and for subgroups defined on the basis of age, sex, and body mass index (BMI).ResultsStudy population totaled 104,368; 44% had hypertension. Relative risk (RR) of developing diabetes was 2.7 (95% CI: 2.6–2.8) for those with vs. without hypertension [21.0 (95% CI: 20.7–21.4) vs. 7.8 (95% CI: 7.6–8.0) per 1000 person-years, respectively]. Adjusted for age, sex, and BMI, RR of diabetes was 1.8 (95% CI: 1.7–1.9). With one exception (men, aged ≥75 years), risk of diabetes was higher across all age and BMI strata for both men and women with vs. without hypertension; differences in risk were greatest among those with high BMI (≥35 kg/m²). Across BMI strata, RR of developing diabetes was generally higher at younger ages.ConclusionAll persons with hypertension, irrespective of age, sex, and BMI, are at elevated risk of developing diabetes. Men and women with hypertension who are overweight or obese are at substantially elevated risk of diabetes, regardless of age, and should be monitored especially closely for the development of this disease.     

Prevalence of Diabetes Mellitus in an Elderly Finnish Population

The prevalence of diabetes mellitus was investigated in a northern Finnish community population aged 70 years or over. Of the eligible 483 persons, 78.5% (n = 379) took part in the study. The presence of diabetes mellitus was assessed by questions about the participants' previously diagnosed diabetes and 2 h oral glucose tolerance tests, which were performed according to the current WHO criteria. Only the participants who were on oral hypoglycaemic drugs or insulin treatment were excluded from the 2 h oral glucose tolerance tests. In the total population the prevalence of Type 2 diabetes was 22.0% among men and 28.2% among women; the difference between sexes was not significant (women's risk ratio (RR) 1.3, 95% confidence interval (CI) 0.9-1.9). Among those aged 80 years or over the risk ratio for women was 11.3 compared with men (95% CI 1.6–79.5). Among men the prevalence was higher in the age group 70–79 years compared with those aged 80 years or over (RR 8.1, 95% CI 1.2–57.1). By contrast, among women, diabetes was less common among those aged 70–79 years compared with those aged 80 years or over (RR 0.6, 95% CI 0.4-1.0). The proportion of undiagnosed diabetes was clearly over one-third among men and just over one-third among women. Of men, 31.9% suffered from impaired glucose tolerance; the corresponding figure for women was 35.3%. The comparatively high proportion of undiagnosed diabetes and impaired glucose tolerance among elderly people lends support to the more frequent use of the 2 h glucose tolerance test in clinical practice.     

Prevalence and associated factors of cardiovascular diseases among men and women aged 45 years and above: Analysis of the longitudinal ageing study in India, 2017–2019

ObjectiveEpidemiological studies on the prevalence and associated factors of cardiovascular diseases (CVDs) representative of all states of India among middle-aged and elderly are not much reported. The present study estimates the prevalence and associated factors of cardiovascular diseases across Indian states among men and women aged ≥45 years.MethodsWe used data from the Longitudinal Ageing Study in India wave 1 (2017–2019), which included a final analytical sample size of 56,935 adults and their spouses aged 45 years and above. We estimated CVDs prevalence for sociodemographic and behavioural variables, and multivariable logistic regression was used to assess the association between behavioural factors and CVDs in both men and women.ResultsThe prevalence of CVDs was 5.2% among adults ≥45 years (women: 4.6%; men: 5.9%), hypertension was 46.7% (women:48.9%; men:44%). Men and women have a similar prevalence of diabetes (11.9%) and cholesterol (2.3%). Prevalence of physical inactivity was 30.3% (women:27%; men:34.1%). Hypertension (adjusted odds ratio; aOR women:2.60, 95% CI: 2.08–3.25, men:1.88, 95% CI 1.54–2.29), hypercholesterolemia (aOR women:1.70; 95% CI 1.07–2.69, men 3.55; 95% CI 2.66–4.74), diabetes (aOR women:2.53; 95% CI 1.83–3.51, men:1.77 95% CI 1.44–2.17), obesity, physical inactivity, and smoking in men were significantly associated with CVDs.ConclusionThe prevalence of CVDs and lifestyle risk factors among middle-aged and elderly poses severe concerns regarding noncommunicable disease (NCD) healthcare services provided in a lower-middle-income country like India. The key to preventing CVDs is controlling hypertension, diabetes, hypercholesterolemia, and increasing physical activity among adults aged ≥45 years.     

High intake of alcohol is associated with newly diagnosed diabetes in 60 years old men and women

Background and aimsLow or moderate alcohol intake has been found to be protective against the incidence of diabetes, while conflicting results have been found regarding high alcohol intake. This study aimed at evaluating the effect of alcohol intake on newly diagnosed diabetes among subjects aged 60 years in relation to anthropometric measurements, life-style and socio-economic factors.Methods and resultsA population-based cross-sectional study of 4106 individuals, 1973 men and 2133 women, aged 60 years, in Stockholm County, Sweden. Medical history, socio-economic factors and life-style data were collected by a questionnaire and a medical examination including laboratory tests. High total intake of alcohol, i.e. >30 g/day vs. 0–30 g/day, was significantly noted more often in newly diagnosed diabetes in men (OR 2.72, 95% CI 1.70–4.34), even when adjusting for other factors, i.e. anthropometric measurements, life-style, socio-economic and dietary factors (adjusted OR 1.94, 95% CI 1.17–3.23); a high intake of spirits, i.e. >15 g/day vs. 0–15 g/day, was significantly more often observed among women (OR 3.97, 95% CI 1.50–10.50), however, it was not significant after adjustment (OR 2.23, 95% CI 0.67–7.42).ConclusionHigh intake of alcohol among men was associated with increased risk of diabetes even when adjusting for other factors.     

SARS-CoV-2 and COVID-19 in diabetes mellitus. Population-based study on ascertained infections,hospital admissions and mortality in an Italian region with ∼5 million inhabitants and ∼250,000 diabetic people

Background and aimsDiabetes conveys an increased risk of infectious diseases and related mortality. We investigated risk of ascertained SARS-CoV-2 infection in diabetes subjects from the Veneto Region, Northeastern Italy, as well as the risk of being admitted to hospital or intensive care unit (ICU), or mortality for COVID-19.Methods and resultsDiabetic subjects were identified by linkage of multiple health archives. The rest of the population served as reference. Information on ascertained infection by SARS-CoV-2, admission to hospital, admission to ICU and mortality in the period from February 21 to July 31, 2020 were retrieved from the regional registry of COVID-19. Subjects with ascertained diabetes were 269,830 (55.2% men; median age 72 years). Reference subjects were 4,681,239 (men 48.6%, median age 46 years). Ratios of age- and gender-standardized rates (RR) [95% CI] for ascertained infection, admission to hospital, admission to ICU and disease-related death in diabetic subjects were 1.31 [1.19–1.45], 2.11 [1.83–2.44], 2.45 [1.96–3.07], 1.87 [1.68–2.09], all p < 0.001. The highest RR of ascertained infection was observed in diabetic men aged 20–39 years: 1.90 [1.04–3.21]. The highest RR of ICU admission and death were observed in diabetic men aged 40–59 years: 3.47 [2.00–5.70] and 5.54 [2.23–12.1], respectively.ConclusionsThese data, observed in a large population of ∼5 million people of whom ∼250,000 with diabetes, show that diabetes not only conveys a poorer outcome in COVID-19 but also confers an increased risk of ascertained infection from SARS-CoV-2. Men of young or mature age have the highest relative risks.     

Metabolic syndrome in first degree relatives of patients with type 2 diabetes: Incidence and risk factors

AimsFirst degree relatives (FDRs) of people with type 2 diabetes are at greater cardiovascular and diabetes risk. It is not known whether they are also at greater risk of metabolic syndrome (MetS). The objectives of present study were to assess the incidence of and risk factors for the development of MetS in FDRs of patients with type 2 diabetes.MethodsA total of 3217 (842 men and 2375 women) FDRs of consecutive patients with type 2 diabetes aged 30–70 years in 2003–2005 were followed through 2010. At baseline participants underwent a standard 75 g 2-h standard OGTT and HbA_1c measurements. MetS was defined by the NCEP-ATP III. The study group consisted of 734 participants without MetS and history of known diabetes at baseline and had at least one subsequent review in mean (SD) follow-up period of 5.5 (1.2) years.ResultsThe prevalence of MetS was 35.8% (95% CI: 34.2, 37.5). The incidence of MetS was 4.3% (95% CI: 3.7, 4.9) (4.6% men and 4.2% women) per year. Multivariate analysis revealed that impaired glucose tolerance (IGT) (RR 1.89 (95% CI: 1.28, 2.79)), impaired fasting glucose (IFG) (RR 1.39 (95% CI: 1.10, 1.73)) and lower HDL (RR 1.34 (95% CI: 1.12, 1.60)) were associated with MetS.ConclusionsThe findings of this study illustrate for the first time the incidence of MetS in FDRs of patients with type 2 diabetes in Iran. Risk of MetS may increases with IGT, IFG and lower HDL.     

The association between obesity and acute myocardial infarction is age- and gender-dependent in a Japanese population

Controversies concerning the association between obesity and acute myocardial infarction (AMI) are still ongoing in Japan. We investigated the association between obesity defined by body mass index of 25 kg/m² or higher and AMI by a case–control study using data from 1199 AMI cases and 4056 apparently healthy controls. The analysis was performed in age- and sex-matched samples of 621 case–control pairs younger than 80 years and in crude samples aged 40–79 years divided into 10-year age groups. Prevalence of obesity, diabetes, current smoking, hypertension, and hypercholesterolemia were compared between cases and controls, and a multivariable odds ratio (OR) of AMI was calculated for each risk factor in various age groups. The OR (95 % confidence interval (CI)) of AMI for obesity was 1.63 (1.23–2.17), P = 0.0008 in men younger than 80 years; 2.65 (1.41–5.00), P = 0.0025 in women younger than 80 years; 2.23 (1.46–3.41), P = 0.0002 in men aged 59 years or younger; 1.34 (0.90–2.01), P = 0.1510 in men aged 60–79 years; and 2.98 (1.56–5.71), P = 0.0010 in women aged 60–79 years using paired samples. The OR (95 % CI) of AMI for obesity was 4.92 (2.53–9.58), P < 0.0001 in men aged 40–49 years; 1.54 (1.07–2.21), P = 0.0197 in men aged 50–59 years; 1.07 (0.69–1.66), P = 0.7717 in men aged 60–69 years; 2.24 (1.20–4.20), P = 0.0118 in men aged 70–79 years; 2.48 (1.12–5.48), P = 0.0245 in women aged 60–69 years; and 3.05 (1.46–6.37), P = 0.0029 in women aged 70–79 years using crude samples. The association between obesity and AMI was age- and gender-dependent in a Japanese population.     

Impaired fasting glucose, diabetes mellitus, and cardiovascular disease risk factors are associated with prolonged QTc duration. Results from the Third National Health and Nutrition Examination Survey

BACKGROUND: Impaired glucose tolerance and diabetes mellitus have been associated with a prolonged QT interval among select populations. However, these associations remain unclear among the general population. METHODS: We examined these relationships using data from 5833 adults aged 40-90 years from NHANES III (1988-1994). Univariate differences in cardiovascular disease (CVD) risk factors were examined across tertiles of heart rate corrected QT (QTc). The association between glucose intolerance, CVD risk factors and a prolonged QTc (> or = 0.440 s) was also assessed with logistic regression adjusting for age, race, gender, education, and heart rate. RESULTS: Prolonged QTc was observed among 22.0% of persons with normal glucose tolerance (NGT), 29.9% of those with impaired fasting glucose (IFG), and among 42.2% of persons with diabetes. Hypertension, serum cholesterol, obesity, heart rate, and fasting C-peptide and serum insulin levels were associated with prolonged QTc (all: P < or = 0.05). After multivariate adjustment, persons with IFG were 1.2 times (95% CI=0.7-2.0) as likely and persons with diabetes 1.6 times (95% CI=1.1-2.3) as likely to have a prolonged QTc as persons with NGT. In addition, persons with diabetes and two or more additional CVD risk factors were 2.3 times (95% CI=1.3-4.0) as likely to have a prolonged QTc as persons with NGT and no CVD risk factors after multivariate adjustment. CONCLUSION: Diabetes was associated with an increased likelihood of prolonged QTc independent of age, race, gender, education, and heart rate. In addition, persons with diabetes and multiple CVD risk factors were more likely to have a prolonged QTc than those with NGT and no additional risk factors, suggesting that these persons may be at increased risk for cardiac arrhythmia and sudden death.     

Type 2 diabetes,socioeconomic status and life expectancy in Scotland (2012–2014): a population-based observational study

Aims/hypothesis

The aim of this study was to assess the role of socioeconomic status (SES) in the associations between type 2 diabetes and life expectancy in a complete national population.

Methods

An observational population-based cohort study was performed using the Scottish Care Information – Diabetes database. Age-specific life expectancy (stratified by SES) was calculated for all individuals with type 2 diabetes in the age range 40–89 during the period 2012–2014, and for the remaining population of Scotland aged 40–89 without type 2 diabetes. Differences in life expectancy between the two groups were calculated.

Results

Results were based on 272,597 individuals with type 2 diabetes and 2.75 million people without type 2 diabetes (total for 2013, the middle calendar year of the study period). With the exception of deprived men aged 80–89, life expectancy in people with type 2 diabetes was significantly reduced (relative to the type 2 diabetes-free population) at all ages and levels of SES. Differences in life expectancy ranged from ?5.5 years (95% CI ?6.2, ?4.8) for women aged 40–44 in the second most-deprived quintile of SES, to 0.1 years (95% CI ?0.2, 0.4) for men aged 85–89 in the most-deprived quintile of SES. Observed life-expectancy deficits in those with type 2 diabetes were generally greater in women than in men.

Conclusions/interpretation

Type 2 diabetes is associated with reduced life expectancy at almost all ages and levels of SES. Elimination of life-expectancy deficits in individuals with type 2 diabetes will require prevention and management strategies targeted at all social strata (not just deprived groups).

     

Prognostic value of resting heart rate in predicting undiagnosed diabetes in adults: Korean National Health and Nutrition Examination Survey 2008–2018

Background and aimAlthough resting heart rate (RHR) is associated with prevalence and incidence of diabetes, whether it is associated with undiagnosed diabetes is still unclear. We aimed to investigate whether the RHR is associated with the prevalence of undiagnosed diabetes in a large Korean national dataset.Methods and resultsThe Korean National Health and Nutrition Examination Survey data from 2008 to 2018 were used. After screening, 51,637 participants were included in this study. The odds ratios and 95% confidence intervals (CIs) for undiagnosed diabetes were calculated using multivariable-adjusted logistic regression analyses.Analyses showed that participants with a RHR of ≥90 bpm showed a 4.00- (95% CI: 2.77–5.77) and 3.21-times (95% CI: 2.01–5.14) higher prevalence of undiagnosed diabetes for men and women, respectively, than those with a RHR of <60 bpm. The linear dose-response analyses showed that each 10-bpm increment in RHR was associated with a 1.39- (95% CI: 1.32–1.48) and 1.28-times (95% CI: 1.19–1.37) higher prevalence of undiagnosed diabetes for men and women, respectively. In the stratified analyses, the positive association between RHR and the prevalence of undiagnosed diabetes was tended to be stronger among those who were younger (age: <40 years) and lean (BMI: <23 kg/m²).ConclusionsElevated RHR was significantly associated with a higher prevalence of undiagnosed diabetes in Korean men and women, independent of demographic, lifestyle, and medical factors. Accordingly, the value of RHR as a clinical indicator and health marker, especially in reducing the prevalence of undiagnosed diabetes, is suggestible.     

Effect of statins on mortality and cardiovascular events in elderly high-risk persons

Review of: MRC/BHF Heart Protection Study of Cholesterol Lowering with Simvastatin in 20,536 High‐Risk Individuals: a Randomized Placebo‐Controlled Trial. Lancet 2002;360:7–22. PURPOSE: To determine the effect of simvastatin 40 mg daily versus placebo on all‐cause mortality and cardiovascular events in high‐risk persons with serum total cholesterol levels of 135 mg/dL or greater. BACKGROUND: Pooled data from three secondary prevention trials of patients with coronary artery disease (CAD) and two primary prevention studies showed that treatment of hypercholesterolemia with statins caused a 31% reduction in major coronary events (95% confidence interval (CI) = 26–36%) and a 21% reduction in all‐cause mortality (95% CI = 14–28%). 1 The secondary prevention trials included 4,444 persons (23% aged 65–70) treated with simvastatin in the Scandinavian Simvastatin Survival Study, 2 , 3 4,159 persons (31% aged 65–75) treated with pravastatin in the Cholesterol and Recurrent Events Trial, 4 - 6 and 9,014 persons (39% aged 65–75) treated with pravastatin in the long‐term Intervention with Pravastatin in Ischaemic Disease Trial. 7 The two primary prevention studies included 6,595 middle‐aged men up to 64 years of age treated with pravastatin in the West of Scotland Coronary Prevention Study 8 and 6,605 persons (22% aged 65–73) treated with lovastatin in the Air Force/Texas Coronary Atherosclerosis Prevention Study. 9 The absolute risk reduction in major coronary events per 1,000 persons treated in these five studies was 33 (13–52) for women versus 37 (29–44) for men and 44 (30–58) for persons aged 65 and older versus 32 (24–40) for younger persons. 1 METHODS: The Heart Protection Study included 20,536 persons (15,454 men and 5,082 women) aged 40 to 80 (5,806 aged 70–80) with serum total cholesterol of 135 mg/dL or greater and prior myocardial infarction (MI) (8,510 persons), other CAD (4,876 persons), or no CAD (7,150 persons). Of the 7,150 participants without CAD, 1,820 had cerebrovascular disease, 2,701 had peripheral arterial disease (PAD), and 3,982 had diabetes mellitus. Although treated hypertension was present in 8,457 persons, only 237 persons were included on the basis of hypertension alone. Patients were randomized to simvastatin 40 mg daily or double‐blind placebo. Mean follow‐up was 5 years. Average compliance was 85% for the simvastatin‐treated group, and 17% of the placebo group took a statin during the 5‐year study. RESULTS: During the 5‐year study, simvastatin reduced serum total cholesterol 46 mg/dL, serum low‐density lipoprotein (LDL) cholesterol 39 mg/dL, and serum triglycerides 12 mg/dL and increased serum high‐density lipoprotein (HDL) cholesterol 1 mg/dL Simvastatin caused a 13% reduction in all‐cause mortality (95% CI = 6–19%), a 17% reduction in any vascular death (95% CI = 9–25%), a 27% reduction in major coronary events (95% CI = 21–33%), a 25% reduction in any stroke (95% CI = 15–34%), a 24% reduction in coronary or noncoronary revascularization (95% CI = 17–30%), and a 24% reduction in any major vascular event (95% CI = 19–28%). Simvastatin significantly reduced the first major vascular event in patients with MI, other CAD, or no CAD; in patients with cerebrovascular disease, PAD, diabetes mellitus, treated hypertension, or no hypertension; in men and in women; in patients aged 40 to 64, 65 to 69, and 70 to 80; in patients with low or high serum total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides; in smokers and nonsmokers; and in patients treated with and without aspirin, beta blockers, and angiotensin‐converting enzyme inhibitors. In the 3,500 persons with an initial serum LDL cholesterol of less than 100 mg/dL, reduction of serum LDL cholesterol from 97 mg/dL to 65 mg/dL by simvastatin caused a similar reduction in risk, as did treating patients with higher serum LDL cholesterol levels. Five years of simvastatin therapy prevented MI, stroke, and revascularization in 70 to 100 per 1,000 treated patients. CONCLUSION: In patients with serum total cholesterol of 135 mg/dL or higher at high risk for vascular events, simvastatin 40 mg daily significantly reduced all‐cause mortality, vascular death, major coronary events, coronary or noncoronary revascularization, and any major vascular event regardless of initial levels of serum lipids, age, or gender.     

Diabetes as a risk factor for greater COVID-19 severity and in-hospital death: A meta-analysis of observational studies

AimsTo estimate the prevalence of established diabetes and its association with the clinical severity and in-hospital mortality associated with COVID-19.Data synthesisWe systematically searched PubMed, Scopus and Web of Science, from 1st January 2020 to 15th May 2020, for observational studies of patients admitted to hospital with COVID-19. Meta-analysis was performed using random-effects modeling. A total of 83 eligible studies with 78,874 hospitalized patients with laboratory-confirmed COVID-19 were included. The pooled prevalence of established diabetes was 14.34% (95% CI 12.62–16.06%). However, the prevalence of diabetes was higher in non-Asian vs. Asian countries (23.34% [95% CI 16.40–30.28] vs. 11.06% [95% CI 9.73–12.39]), and in patients aged ≥60 years vs. those aged <60 years (23.30% [95% CI 19.65–26.94] vs. 8.79% [95% CI 7.56–10.02]). Pre-existing diabetes was associated with an approximate twofold higher risk of having severe/critical COVID-19 illness (n = 22 studies; random-effects odds ratio 2.10, 95% CI 1.71–2.57; I² = 41.5%) and ~threefold increased risk of in-hospital mortality (n = 15 studies; random-effects odds ratio 2.68, 95% CI 2.09–3.44; I² = 46.7%). Funnel plots and Egger's tests did not reveal any significant publication bias.ConclusionsPre-existing diabetes is significantly associated with greater risk of severe/critical illness and in-hospital mortality in patients admitted to hospital with COVID-19.