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Effects of Diabetes and Level of Glycemia on All-Cause and Cardiovascular Mortality: The San Antonio Heart Study
Ming Wei, MD, MPH,
Sharon P Gaskill, MPH,
Steven M Haffner, MD and
Michael P Stern, MD
Cooper Institute for Aerobics Research Dallas
Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio San Antonio, Texas
Address correspondence and reprint requests to Michael P. Stern, MD, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, Texas 78284-7873. E-mail: stern{at}uthscsa.edu
Diabetes Care 1998 Jul; 21(7): 1167-1172. https://doi.org/10.2337/diacare.21.7.1167
OBJECTIVE Although the level of hyperglycemia is clearly a risk factor for microvascular complications in diabetic patients, its role in macrovascular complications remains controversial. We followed 4,875 subjects (65% Mexican-American) for 7–8 years to investigate the effects of diabetes and hyperglycemia on all-cause and cardiovascular disease (CVD) mortality. These end points were also analyzed according to quartiles of baseline fasting plasma glucose among diabetic participants.
RESEARCH DESIGN AND METHODS The Cox proportional hazards model was used to estimate the relative risks (RRs) for all-cause and CVD mortality.
RESULTS Diabetes was significantly associated with increased all-cause mortality (RR [95% CI] = 2.1 [1.3–3.5] in men; 3.2 [1.9–5.4] in women) and increased CVD mortality (3.2 [1.4–7.1] in men; 8.5 [2.8–25.2] in women). Among diabetic subjects, those in quartile 4 had a 4.2-fold greater risk of all-cause mortality (P < 0.001) and a 4.7-fold greater risk of CVD mortality (P = 0.01) than those in quartiles 1 and 2 combined. After further adjustment for other potential risk factors, subjects in quartile 4 had a 4.9-fold greater risk of all-cause mortality and a 4.9-fold greater risk of CVD mortality than those in quartiles 1 and 2. In addition, hypertension, current smoking, and cholesterol >6.2 mmol/1 were significant predictors of CVD mortality using Cox models.
CONCLUSIONS We conclude that diabetes is a predictor of both all-cause and CVD mortality in the general population and that both hyperglycemia and common CVD risk factors are important predictors of all-cause and CVD mortality in diabetic subjects.
Revision received March 16, 1998.
July 1998, 21(7)
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Ming Wei, Sharon P Gaskill, Steven M Haffner, Michael P Stern
Diabetes Care Jul 1998, 21 (7) 1167-1172; DOI: 10.2337/diacare.21.7.1167
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