Associations Between Multiple Cardiovascular Disease Risk Factors and Diabetes Among Asymptomatic Individuals in a Hard To-Reach Population

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Background: Diabetes is the sixth leading cause of death in the United States (U.S), and a major risk factor for cardiovascular disease (CVD). The prevalence of diabetes in central Appalachian region is higher than the rest of the nation (14.4% versus 9.0%, respectively). Objectives: Examine the association between multiple risk factors for CVD and diabetes in asymptomatic adults in central Appalachia. Methods: Between January 2012 and July 2016, 3,000 community-dwelling asymptomatic individuals from central Appalachia participated in screening for sub-clinical atherosclerosis. Participants were asked to report their diabetes status (yes/no). In addition, data on coronary artery calcium (CAC), a marker for sub-clinical coronary atherosclerosis, in quartiles (0, 1-99, 100-399, ≥400), obesity (body mass index ≥30 kg/m2), hypercholesterolemia (yes/no), hypertension (yes/no), current smoking (yes/no), sedentary lifestyle (yes/no), and family history of coronary artery disease (CAD) (yes/no), were collected. Multivariable logistic regression analyses were conducted to assess association between CVD risk factors and diabetes. Results: Of the 3,000 participants, 2,509 subjects (mean age: 58.3 years; SD = 9.8 years) had complete data on variables of interest. Approximately, 14% of the study population reported having type 2 diabetes. Among subjects with diabetes, 58% had a CAC score ≥1, 22% were obese, 17% had hypercholesterolemia, 20% had hypertension, 16% were current smokers, 17% had a sedentary lifestyle, and 15% had a family history of CAD. After adjusting for sex and age, having a CAC score of 1-99, 100-399, and ≥400 increased the odds of having diabetes (Odds ratio (OR): 1.4, 95% Confidence interval (CI) = 1.02-1.9; OR: 2.0, 95% CI = 1.4-2.8; OR: 3.1, 95% CI = 2.1-4.7, respectively) in a linear fashion. Being obese (OR: 3.2; 95% CI = 2.5-4.0), having hypercholesterolemia (OR: 1.8; 95% CI=1.4-2.4), being hypertensive (OR: 3.0; 95% CI= 2.3-3.8), being a smoker (OR: 1.5; 95% CI = 1.1-2.1), and being sedentary (OR: 1.6; 95% CI = 1.3-2.0) were significantly associated with diabetes. Having three (OR: 3.0; 95% CI=1.3-6.6), four (OR: 4.4; 95% CI=2.0-9.7), five (OR: 7.0; 95% CI=3.1-16.1) or six (OR: 9.9; 95% CI= 3.5-27.7) CVD risk factors significantly increased the odds of diabetes. Subjects with any of the seven risk factors under study were 1.7 times (95% CI= 1.5-1.9) more likely to have diabetes. Conclusion. Odds of type 2 diabetes increase with higher number of risk factors for CVD. Results support the use of multifaceted CVD and diabetes prevention programs to lower the incidence of type 2 diabetes.


Atlanta, GA

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