Modifiable Risk Factors in Midlife and the Age of Onset of Diabetes Mellitus: A 34-Year Follow-Up Study

BACKGROUND: Alzheimer’s disease (AD), the most common cause of dementia, is evolving to become a threatening epidemy of the 21st century. Only 21% of the predicted number of AD patients in Macedonia have been diagnosed and treated, which means that almost 80% are underdiagnosed or misdiagnosed. Apolipoprotein E gene (APOE) is recognised as the strongest genetic risk factor for sporadic AD. Whether and when Alzheimer’s disease develops, depends on the very complex interaction between genetic and modifiable risk factors. It has been known that vascular factors like hypertension, diabetes mellitus, hypercholesterolemia and obesity increase the risk of developing both AD, vascular dementia and mixed AD and vascular pathology AIM: This study aims to evaluate the influence of APOEε4 allele presence and modifiable vascular risk factors (hypertension, diabetes mellitus and dyslipidemia) as prognostic and risk factors for AD and their influence on the age of onset of AD symptoms among 144 AD patients from Macedonia. MATERIAL AND METHODS: Study group of a total of 144 patients diagnosed with AD was evaluated. APOE genotyping was performed using APOE haplotype-specific sequence specific-primer (SSP)-PCR (Polymerase Chain Reaction) methodology. The non-standardized questionnaire was used to obtain information about demographics, lifestyle and modifiable risk factors that could influence disease onset and phenotype. RESULTS: Statistically significant association was found between the presences of APOEε4 allele in AD group versus controls. The presence of APOEε4 allele increases the risk of developing AD in a 3-fold manner. The average age of disease onset in the ε4 carrier group was 67.2 ± 8.3 and in the ε4 non-carrier group 69.7 ± 9.4. This confirms that the presence of APOEε4 allele shifts towards earlier disease onset, though the difference is not statistically significant. Out of the vascular risk factors, only hypertension was significantly associated with earlier AD onset. Out of total 144 patients, in 22.9% the first symptom onset was before the age of 65, that can be considered as early onset Alzheimer’s Disease (EOAD), which is much higher than 5% for EOAD as most of the studies report. CONCLUSIONS: The average age of disease onset of 68.4 years could be considered earlier than the average age of AD onset worldwide. Out of all the vascular risk factors analysed in this study, only hypertension and dyslipidemia were found to significantly increase the risk for developing AD and only the presence of hypertension influences the age of onset, shifting towards earlier disease onset. Public awareness campaigns should be organised to influence general population knowledge about Alzheimer’s disease, early recognition and the influence of modifiable vascular risk factors.

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POS1140 RISK FACTORS FOR THE DEVELOPMENT OF DIABETES MELLITUS IN PATIENTS WITH GOUT ACCORDING TO A 6-YEAR PROSPECTIVE FOLLOW-UP STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3151 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 849.2-849

Author(s):

O. Sheliabina ◽

M. Elisеev ◽

A. Novikova ◽

M. Chikina

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Family History ◽

Clinical Manifestations ◽

Reactive Protein ◽

Follow Up Study ◽

Lowering Therapy

Background:Gout is often associated with diabetes mellitus (DM), but the role of serum uric acid (sUA) and urate-lowering drugs in its development in patients with gout remains controversial [1].Objectives:To study risk factors for DM in patients with gout based on the results of long-term prospective follow-up study.Methods:The prospective study included 444 patients with a crystal-verified diagnosis of gout, aged ≥18 years, 49 (11%) women, 395 (89%) men. Patients were followed up at the V.A. Nasonova Research Institute of Rheumatology from 2010 to January 2021, the median follow-up was 6.1 [2.8; 7.8] years. The exclusion criteria were the presence of other rheumatic diseases with symptoms of arthritis, DM. DM was diagnosed on the 1998 WHO criteria. The following parameters were considered as risk factors: gender, family history for diabetes mellitus, body mass index (BMI)>25 kg/m2 and > 30 kg/m2, waist volume ≥88 cm for women and ≥102 cm for men, alcohol consumption > 20 units per week, chronic kidney disease (CKD), intake of diuretics and glucocorticoids, and serum total cholesterol >5 mmol/l, triglycerides>2.25 mmol/l, serum C-reactive protein (CRP) level> 5 mg/l, as well as clinical manifestations of gout: subcutaneous tophi, polyarthritis (simultaneous involvement of ≥5 joints), intake of urate-lowering drugs, sUA (> 480 μmol/L,> 420 μmol/L,> 360 μmol/L,> 300 μmol/L). Statistica 12.0 package was used for statistical data processing.Results:A total of 444 patients were included, the mean age was 51.0±12.9 years, the median follow-up was 6.1 [2.8; 7.8] years. In dynamics: 35 (8%) patients died, 6 (1%) patients were not available, 403 patients were examined (44 (11%) - women and 359 (89%) - men). 290 (72%) patients received urate-lowering therapy (263 (65%) patients used allopurinol, 27 (7%) - febuxostat). The target sUA <360 μmol/L was reached by 165 (41%) patients and <300 μmol/L - by 92 (23%) patients. All patients with sUA<300 μmol/L received urate-lowering therapy, 62 (67%) patients used allopurinol, 17 (18%) - febuxostat, 13 (14%) - uricosuric drugs. Diabetes mellitus was developed in 106 (26%) patients. The factors influencing the risk of developing diabetes were - the presence of diabetes in family history (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.37; 3.76); BMI> 30 kg / m2 (OR 1.79, 95% CI 1.14; 2.80), diuretics (OR 2.32, 95% CI 1.36; 3.96) and sUA> 300 μmol / l (OR 2.89, 95% CI 1.50, 5.56).Conclusion:The risk of developing DM in patients with gout is associated with sUA> 300 μmol/l, which may be one of the probable reasons for choosing this as a target level. Large prospective studies are needed to confirm the antidiabetic effect of urate-lowering drugs.References:[1]Chang HW, Lin YW, Lin MH, Lan YC, Wang RY. Associations between urate-lowering therapy and the risk of type 2 diabetes mellitus. PLoS One. 2019 Jan 7;14(1):e0210085. doi: 10.1371/journal.pone.0210085.Disclosure of Interests:Olga Sheliabina: None declared, Maxim Elisеev Speakers bureau: Berlin Chemie Menarini Group, Novartis International AG, EGIS, Aleksandra Novikova: None declared, Maria Chikina: None declared.

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1003Modifiable risk factors and incidence of diabetes mellitus progressing in the prediabetic Population

International Journal of Epidemiology ◽

10.1093/ije/dyab168.284 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Kwan Hong ◽

Eun Sun Yu ◽

Byung Chul Chun

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Alcohol Consumption ◽

Incidence Rate ◽

National Health ◽

Progression Rate ◽

Modifiable Risk Factors ◽

Adjusted Incidence Rate ◽

Adjusted Incidence

Abstract Background Although the prevention of diabetes mellitus is important, factors related to its progression in the prediabetic population are rarely revealed. This study aimed to estimate the rate of progression and uncover the modifiable risk factors leading to progression. Methods We constructed a group from the National Health Screening Cohort, consisting of adults who received national health screening tests in 2002. After selecting a prediabetic population, we classified them into two groups based on their diabetes progression after a 13-year follow up. The adjusted incidence rate was estimated, and the Cox proportional hazard modelling was performed to identify risk factors for progression. Results The progression rate of diabetes in the prediabetic population (88,330) was 22.85% (20,184), with an adjusted incidence rate of 25.18 (95% confidence interval, CI: 24.44 – 26.02) per 1,000 person-year, ages 40-64 and 25.69 (95% CI: 24.46 – 26.95) in those 65 or older. Among modifiable risk factors, smoking showed the highest hazard ratio, 1.21 (95% CI: 1.16 – 1.25), followed by BMI and alcohol consumption with hazard ratios of 1.06 (95% CI: 1.06 – 1.07) and 1.06 (95% CI: 1.02 – 1.09), respectively. Conclusions Considering the high progression rate of the prediabetic population, modifiable risk factors, such as smoking, should be managed. Key messages The progression rate of the prediabetic population was 25–26% per 1,000 person-year. At the 13-year follow up, modifiable risk factors, such as smoking, BMI, and alcohol consumption, affected the prediabetic population.

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