OBJECTIVES: The study was conducted to test the hypothesis that the prevalence of coronary amerosclerosis is greater among diabetic than among nondiabetic individuals and is similar for diabetic individuals without clinical coronary artery disease (CAD) and nondiabetics with clinical CAD. BACKGROUND: Persons with diabetes bur without clinical CAD encounter cardiovascular mortality similar to nondiabetic individuals with clinical CAD. This excess mortality is nor fully explained. We examined the association between diabetes and coronary arherosclerosis in a geographically defined autopsied population, while capitalizing on the autopsy rate and medical record linkage system available via the Rochester Epidemiology Project, which allows rigorous ascertainment of coronary arherosclerosis, clinical CAD, and diabetes. METHODS: Using two measures, namely a global coronary score and high-grade stenoses, the prevalence of arherosclerosis was analyzed in a cohort of autopsied residents of Rochester, Minnesota, age 30 years or older ar death, while stratifying on diabetes, clinical CAD diagnosis, age, and gender. RESULTS: In this cohort, diabetes was associated with a higher prevalence of atherosclerosis. Among diabetic decedents without clinical CAD, almost three-fourths had high-grade coronary arherosclerosis and more than half had multivessel disease. Without diabetes, women had less arherosclerosis than men, but this female advantage was lost with diabetes. Among those without clinical CAD, diabetes was associated with a global coronary disease burden and a prevalence of high-grade arherosclerosis similar to that observed among nondiabetic subjects with clinical CAD. CONCLUSIONS: These findings provide mechanistic insights into the excess risk of clinical CAD among diabetic individuals, thereby supporting the need for aggressive prevention of atherosclerosis in all diabetic individuals, irrespective of clinical CAD symptoms.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine