Age, gender, insulin and blood glucose control status alter the risk of ischemic heart disease and stroke among elderly diabetic patients

Cardiovascular Diabetology

Original Investigation

Masao Yoshizumi¹  Hiroshi Watanabe²  Yoshiyuki Hattori³  Hirohito Sone⁴  Takashi Ohrui⁵  Toshio Hayashi⁶  Koichiro Ina⁶  Hideki Nomura⁷  Kiyoshi Kubota⁸  Koutaro Yokote⁹  Seinosuke Kawashima^1,10  Hideki Itoh^1,11 

[1] Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan;Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan;Department of Endocrinology and Metabolism, Dokkyo University School of Medicine, Mibu, Japan;Department of Endocrinology and Metabolism, University of Tsukuba Mito Medical Center, Mito, Japan;Department of Geriatric Medicine, Tohoku University School of Medicine, Sendai, Japan;Department of Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan;Department of Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan;Department of Geriatrics, Nagoya Ajima Clinics, Nagoya, Japan;Department of Phamacoepdiemiology, Graduate School of Medicine and Faculty of Medicine, the University of Tokyo, Japan;Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Chiba University Graduate School of Medicine, Chiba, Japan;Division of Internal Medicine, Nakatsu Saiseikai Hospital, Osaka, Japan;Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan;

关键词: Elderly;    Diabetes mellitus;    Insulin;    Cerebral ischemia;    Ischemic heart disease;   

DOI  :  10.1186/1475-2840-10-86

 received in 2011-08-30, accepted in 2011-10-06,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundWe analyzed the effects of insulin therapy, age and gender on the risk of ischemic heart disease (IHD) and cerebrovascular accident (CVA) according to glycemic control.Methods and ResultsWe performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study) of type 2 diabetes patients (n = 4014) for 2 years. The primary endpoint was the onset of fatal/non-fatal IHD and/or CVA, which occurred at rates of 7.9 and 7.2 per 1000 person-years, respectively. We divided diabetic patients into four groups based on age (≤ 70 and > 70) and hemoglobin A1C levels (≤ 7.0 and > 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure and low HDL-C in patients under 70 years of age with fair glycemic control and was associated with low diastolic blood pressure in the older/fair group. Interestingly, insulin use was associated with IHD in the older/poor group (OR = 2.27, 95% CI = 1.11-5.89; p = 0.026) and was associated with CVA in the older/fair group (OR = 2.09, 95% CI = 1.06-4.25; p = 0.028). CVA was associated with lower HDL-C and longer duration of diabetes in younger/poor glycemic control group. Results by stepwise analysis were similar. Next, patients were divided into four groups based on gender and diabetic control(hemoglobinA1C < or > 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure in male/fair glycemic control group, age in male/poor control group, and short duration of diabetic history in females in both glycemic control groups. Interestingly, insulin use was associated with IHD in the male/poor group(OR = 4.11, 95% CI = 1.22-8.12; p = 0.018) and with CVA in the female/poor group(OR = 3.26, 95% CI = 1.12-6.24; p = 0.02). CVA was associated with short duration of diabetes in both female groups.ConclusionsIHD and CVA risks are affected by specific factors in diabetics, such as treatment, gender and age. Specifically, insulin use has a potential role in preventing IHD but may also be a risk factor for CVA among the diabetic elderly, thus revealing a need to develop improved treatment strategies for diabetes in elderly patients. The Japan Cholesterol and Diabetes Mellitus Study was formulated to evaluate them(Umin Clinical Trials Registry, clinical trial reg. no. UMIN00000516; http://www.umin.ac.jp/ctr/index.htm).

【 授权许可】

CC BY   
© Hayashi et al; licensee BioMed Central Ltd. 2011