Identification and Predictors for Cardiovascular Disease Risk Equivalents among Adults With Diabetes Mellitus

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/1.73m², 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>

Identification and Predictors for Cardiovascular Disease Risk Equivalents among Adults With Diabetes Mellitus

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/1.73m², 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>

Fish harvesting advice under climate change: A risk-equivalent empirical approach

The rate of climate change (CC) has accelerated to the point where it now affects the mid- to long-term sustainability of fishing strategies. Therefore, it is important to consider practical and effective ways to incorporate CC into fisheries advice so that the advice can be considered conditioned to CC. We developed a model to characterise the empirical relationship between a variable affected by climate and fish production. We then used model projections as a foundation for a risk analysis of CC effects on harvesting of Greenland halibut Reinhardtius hippoglossoides in the Gulf of St Lawrence, Canada. The risk-based approach quantified a) the relative change in risk of a status quo fishing strategy under various CC scenarios, and b) the change in fishery exploitation rates required to achieve a management objective over a specified time period at a level of risk considered acceptable (risk equivalent fishery exploitation advice). This empirical approach can be used to develop risk-based advice for any other external variable that affects stock production in addition to climate-related variables and it can be applied in most situations where there is an index of stock biomass and fisheries catch. Shifting the focus from process-based understanding of the responses of fish stocks to CC to quantification of how CC-contributed uncertainty can alter the risks associated with different fishing strategies and/or management options, can ensure timely delivery of robust scientific advice for fisheries under non-stationary environmental conditions.

Abstract 14434: Identification and Predictors for Cardiovascular Disease Risk Equivalents Among Adults With Diabetes Mellitus

Background: It is not well quantified if diabetes mellitus (DM) as a cardiovascular disease (CVD) risk equivalent depends on DM severity and other CVD risk factors. Methods: We pooled 4 US community-based cohorts (ARIC, JHS, MESA, FHS Offspring) and classified subjects by baseline DM/CVD status. DM+/CVD- was further classified by DM duration, HbA1c control or DM medication. Hazard ratios (HR) were estimated for CVD during a median follow-up of 14 years. Subgroup analysis comparing the HR of DM+/CVD- vs. DM-/CVD+ was done by CVD risk factors. We integrated all factors that impacted DM-conferred CVD risk and defined one with DM+/CVD- as CVD risk equivalent when his/her CVD risk was as high or higher than that if he/she had DM-/CVD+. CVD risk profile and event risk were compared between the CVD risk equivalent subgroups in DM+/CVD-. Results: The pooled cohort included 27,732 adults (mean age of 58 years, 45% males). CVD event rates per 1000 P-Y were 16.3, 33.3, 40.9 and 69.0 among those with DM-/CVD-, DM+/CVD-, DM-/CVD+ and DM+/CVD+, respectively. DM participants with HbA1c≥7%, DM duration over 10 years, or DM medication use had similar CVD risk as those with DM-/CVD+ while those without these factors had lower CVD risk; DM+/CVD- had similar CVD risk as those DM-/CVD+ among women, age <55 years, White race, or high triglyceride groups (Figure). Among those with DM+/CVD-, 17.5% were found to be CVD risk equivalents. Compared to those non-CVD risk equivalent DM, they had lower 10-year PCE scores (14.8% vs. 22.7%, p<0.0001) however higher actual CVD event rates (44.9 vs. 31.0 per 1000 P-Y). Conclusion: Among CVD-free adults with DM, fewer than 20% are actually CVD risk equivalents. Poor HbA1c control, long DM duration, and current diabetes medication use were identified as predictors of CVD risk equivalent status and DM was more detrimental for CVD risk if one is female, younger age, White, or with high triglycerides. These risk enhancing factors should be considered in the treatment decision.

Fish harvesting advice under climate change: a risk-equivalent empirical approach

1AbstractThe rate of climate change (CC) has accelerated to the point where it now affects the mid-to long-term sustainability of fishing strategies. Therefore, it is important to consider practical and effective ways to incorporate CC into fisheries advice so that the advice can be considered conditioned to CC. We developed a quantitative model to characterise the empirical relationship between a variable affected by climate and fish production. We then used model projections as a foundation for a risk analysis of CC effects on harvesting of Greenland halibut Reinhardtius hippoglossoides in the Gulf of St Lawrence, Canada. The risk-based approach quantified a) the relative change in risk of a status quo fishing strategy under various CC scenarios, and b) the change in fishery exploitation rates required to achieve a management objective over a specified time period at a level of risk considered acceptable (risk equivalent fishery exploitation advice). This empirical approach can be used to develop risk-based advice for any other external variable that affects stock production in addition to climate-related variables and it can be applied in most situations where there is an index of stock biomass and fisheries catch. Shifting the focus from process-based understanding of the responses of fish stocks to CC to quantification of how CC-contributed uncertainty can alter the risks associated with different fishing strategies and/or management options, can ensure timely delivery of robust scientific advice for fisheries under non-stationary environmental conditions.