Objective:
We examined diabetes mellitus (DM) as a cardiovascular disease (CVD) risk
equivalent based on diabetes severity and other CVD risk factors.
<p>Research
Design and Methods: We pooled 4 US cohorts (ARIC, JHS, MESA, FHS-Offspring) and
classified subjects by baseline DM/CVD. CVD risks between DM+/CVD- vs. DM-/CVD+
were examined by diabetes severity and in subgroups of other CVD risk factors. We
developed an algorithm to identify subjects with CVD risk equivalent diabetes by
comparing the relative CVD risk of being DM+/CVD- vs. DM-/CVD+. </p>
<p>Results: The
pooled cohort included 27,730 subjects (mean age of 58.5 years, 44.6% male).
CVD rates per 1000 person-years were 16.5, 33.4, 43.2 and 71.4 among those with
DM-/CVD-, DM+/CVD-, DM-/CVD+ and DM+/CVD+, respectively. Compared to those with
DM-/CVD+, CVD risks were similar or higher for those with HbA1c≥7%, diabetes duration ≥10 years, or diabetes medication
use while those with less severe diabetes had lower risks. Hazard ratios for DM+/CVD-
vs. DM-/CVD+ were 0.96(0.86-1.07), 0.97(0.88-1.07), 0.96(0.82-1.13),
1.18(0.98-1.41), 0.93(0.85-1.02) and 1.00(0.89-1.13) among women, white race, age
<55 years, triglycerides ≥2.26mmol/L, CRP≥2mg/L and eGFR<60mL/min/1.73m<sup>2</sup>, respectively. In DM+/CVD-
group, 19.1% had CVD risk equivalent diabetes with a lower risk score but a higher
observed CVD risk. </p>
<p>Conclusion:
Diabetes is a CVD risk equivalent in one-fifth of CVD-free adults living with
diabetes. High HbA1c, long diabetes duration, and diabetes medication use were predictors
of CVD risk equivalence. Diabetes is a CVD risk equivalent for women, white people,
those of younger age, with higher triglycerides or CRP, or reduced kidney
function. </p>