Skip to main content
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2002 Dec;94(12):1025–1035.

Incidence and risk factors for cardiovascular disease in African Americans with diabetes: the Atherosclerosis Risk in Communities (ARIC) study.

Ayokanmi Adeniyi 1, Aaron R Folsom 1, Frederick L Brancati 1, Moise Desvorieux 1, James S Pankow 1, Herman Taylor 1
PMCID: PMC2568397  PMID: 12510702

Abstract

To determine the incidence rate of cardiovascular disease (CVD) and its association with conventional and less well-established risk factors in African Americans with diabetes, we studied 741 African Americans aged 45 to 64 years with diabetes, in the Atherosclerosis Risk in Communities (ARIC) study. Risk factors were measured from 1987 to 1989, and incident CVD (n = 143 coronary heart disease (CHD) or stroke events) was ascertained through 1998. The crude incidence rate (per 1000 person-years) of CVD was 22.5 (11.9 for CHD and 12.0 for stroke). After multivariate adjustments, total cholesterol, prevalent hypertension and current smoking were significantly and positively associated with incident CVD among these African Americans with diabetes. Among the non-conventional risk factors, serum creatinine, factor VIII, von Willebrand factor, and white blood cell count were positively and serum albumin negatively and independently associated with CVD incidence. Adjusted relative risks for highest versus lowest tertiles of these risk factors ranged from 1.77 to 2.13. This study confirms that the major risk factors (hypercholesterolemia, hypertension and smoking) are important determinants of CVD in African Americans with diabetes. In addition, several blood markers of hemostasis or inflammatory response and elevated serum creatinine also proved to be CVD risk factors in African Americans with diabetes.

Full text

PDF
1025

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baecke J. A., Burema J., Frijters J. E. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982 Nov;36(5):936–942. doi: 10.1093/ajcn/36.5.936. [DOI] [PubMed] [Google Scholar]
  2. Colwell J. A. Aspirin therapy in diabetes. Diabetes Care. 1997 Nov;20(11):1767–1771. doi: 10.2337/diacare.20.11.1767. [DOI] [PubMed] [Google Scholar]
  3. Conlan M. G., Folsom A. R., Finch A., Davis C. E., Sorlie P., Marcucci G., Wu K. K. Associations of factor VIII and von Willebrand factor with age, race, sex, and risk factors for atherosclerosis. The Atherosclerosis Risk in Communities (ARIC) Study. Thromb Haemost. 1993 Sep 1;70(3):380–385. [PubMed] [Google Scholar]
  4. Doumas B. T., Watson W. A., Biggs H. G. Albumin standards and the measurement of serum albumin with bromcresol green. Clin Chim Acta. 1971 Jan;31(1):87–96. doi: 10.1016/0009-8981(71)90365-2. [DOI] [PubMed] [Google Scholar]
  5. Eckfeldt J. H., Chambless L. E., Shen Y. L. Short-term, within-person variability in clinical chemistry test results. Experience from the Atherosclerosis Risk in Communities Study. Arch Pathol Lab Med. 1994 May;118(5):496–500. [PubMed] [Google Scholar]
  6. Ernst E., Hammerschmidt D. E., Bagge U., Matrai A., Dormandy J. A. Leukocytes and the risk of ischemic diseases. JAMA. 1987 May 1;257(17):2318–2324. [PubMed] [Google Scholar]
  7. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001 May 16;285(19):2486–2497. doi: 10.1001/jama.285.19.2486. [DOI] [PubMed] [Google Scholar]
  8. Folsom A. R., Ma J., Eckfeldt J. H., Nieto F. J., Metcalf P. A., Barnes R. W. Low serum albumin. Association with diabetes mellitus and other cardiovascular risk factors but not with prevalent cardiovascular disease or carotid artery intima-media thickness. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Ann Epidemiol. 1995 May;5(3):186–191. doi: 10.1016/1047-2797(94)00105-3. [DOI] [PubMed] [Google Scholar]
  9. Folsom A. R., Szklo M., Stevens J., Liao F., Smith R., Eckfeldt J. H. A prospective study of coronary heart disease in relation to fasting insulin, glucose, and diabetes. The Atherosclerosis Risk in Communities (ARIC) Study. Diabetes Care. 1997 Jun;20(6):935–942. doi: 10.2337/diacare.20.6.935. [DOI] [PubMed] [Google Scholar]
  10. Folsom A. R., Wu K. K., Rosamond W. D., Sharrett A. R., Chambless L. E. Prospective study of hemostatic factors and incidence of coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 1997 Aug 19;96(4):1102–1108. doi: 10.1161/01.cir.96.4.1102. [DOI] [PubMed] [Google Scholar]
  11. Fuller J. H., Stevens L. K., Wang S. L. Risk factors for cardiovascular mortality and morbidity: the WHO Mutinational Study of Vascular Disease in Diabetes. Diabetologia. 2001 Sep;44 (Suppl 2):S54–S64. doi: 10.1007/pl00002940. [DOI] [PubMed] [Google Scholar]
  12. Gaubatz J. W., Ghanem K. I., Guevara J., Jr, Nava M. L., Patsch W., Morrisett J. D. Polymorphic forms of human apolipoprotein[a]: inheritance and relationship of their molecular weights to plasma levels of lipoprotein[a]. J Lipid Res. 1990 Apr;31(4):603–613. [PubMed] [Google Scholar]
  13. Getz G. S. Report on the workshop on diabetes and mechanisms of atherogenesis. September 17th and 18th, 1992, Bethesda, Maryland. Arterioscler Thromb. 1993 Mar;13(3):459–464. doi: 10.1161/01.atv.13.3.459. [DOI] [PubMed] [Google Scholar]
  14. Gillum R. F. Risk factors for stroke in blacks: a critical review. Am J Epidemiol. 1999 Dec 15;150(12):1266–1274. doi: 10.1093/oxfordjournals.aje.a009957. [DOI] [PubMed] [Google Scholar]
  15. Grundy S. M., Benjamin I. J., Burke G. L., Chait A., Eckel R. H., Howard B. V., Mitch W., Smith S. C., Jr, Sowers J. R. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation. 1999 Sep 7;100(10):1134–1146. doi: 10.1161/01.cir.100.10.1134. [DOI] [PubMed] [Google Scholar]
  16. Harris M. I. Noninsulin-dependent diabetes mellitus in black and white Americans. Diabetes Metab Rev. 1990 Mar;6(2):71–90. doi: 10.1002/dmr.5610060202. [DOI] [PubMed] [Google Scholar]
  17. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998 Sep 12;352(9131):837–853. [PubMed] [Google Scholar]
  18. Juhan-Vague I., Alessi M. C., Vague P. Thrombogenic and fibrinolytic factors and cardiovascular risk in non-insulin-dependent diabetes mellitus. Ann Med. 1996 Aug;28(4):371–380. doi: 10.3109/07853899608999095. [DOI] [PubMed] [Google Scholar]
  19. Kannel W. B., D'Agostino R. B., Wilson P. W., Belanger A. J., Gagnon D. R. Diabetes, fibrinogen, and risk of cardiovascular disease: the Framingham experience. Am Heart J. 1990 Sep;120(3):672–676. doi: 10.1016/0002-8703(90)90026-t. [DOI] [PubMed] [Google Scholar]
  20. Kannel W. B., McGee D. L. Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study. Diabetes Care. 1979 Mar-Apr;2(2):120–126. doi: 10.2337/diacare.2.2.120. [DOI] [PubMed] [Google Scholar]
  21. Kinlay S., Selwyn A. P., Libby P., Ganz P. Inflammation, the endothelium, and the acute coronary syndromes. J Cardiovasc Pharmacol. 1998;32 (Suppl 3):S62–S66. [PubMed] [Google Scholar]
  22. Królewski A. S., Czyzyk A., Janeczko D., Kopczyński J. Mortality from cardiovascular diseases among diabetics. Diabetologia. 1977 Aug;13(4):345–350. doi: 10.1007/BF01223277. [DOI] [PubMed] [Google Scholar]
  23. Maciejko J. J., Mao S. J. Radioimmunoassay of apolipoprotein A-i. application of a non-ionic detergent (Tween-20) and solid-phase staphylococcus. Clin Chem. 1982 Jan;28(1):199–204. [PubMed] [Google Scholar]
  24. Malmberg K. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ. 1997 May 24;314(7093):1512–1515. doi: 10.1136/bmj.314.7093.1512. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Mattock M. B., Barnes D. J., Viberti G., Keen H., Burt D., Hughes J. M., Fitzgerald A. P., Sandhu B., Jackson P. G. Microalbuminuria and coronary heart disease in NIDDM: an incidence study. Diabetes. 1998 Nov;47(11):1786–1792. doi: 10.2337/diabetes.47.11.1786. [DOI] [PubMed] [Google Scholar]
  26. Mokdad A. H., Bowman B. A., Ford E. S., Vinicor F., Marks J. S., Koplan J. P. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001 Sep 12;286(10):1195–1200. doi: 10.1001/jama.286.10.1195. [DOI] [PubMed] [Google Scholar]
  27. Morigi M., Angioletti S., Imberti B., Donadelli R., Micheletti G., Figliuzzi M., Remuzzi A., Zoja C., Remuzzi G. Leukocyte-endothelial interaction is augmented by high glucose concentrations and hyperglycemia in a NF-kB-dependent fashion. J Clin Invest. 1998 May 1;101(9):1905–1915. doi: 10.1172/JCI656. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Moss S. E., Klein R., Klein B. E. Cause-specific mortality in a population-based study of diabetes. Am J Public Health. 1991 Sep;81(9):1158–1162. doi: 10.2105/ajph.81.9.1158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Nägele U., Hägele E. O., Sauer G., Wiedemann E., Lehmann P., Wahlefeld A. W., Gruber W. Reagent for the enzymatic determination of serum total triglycerides with improved lipolytic efficiency. J Clin Chem Clin Biochem. 1984 Feb;22(2):165–174. doi: 10.1515/cclm.1984.22.2.165. [DOI] [PubMed] [Google Scholar]
  30. Patsch W., Brown S. A., Morrisett J. D., Gotto A. M., Jr, Patsch J. R. A dual-precipitation method evaluated for measurement of cholesterol in high-density lipoprotein subfractions HDL2 and HDL3 in human plasma. Clin Chem. 1989 Feb;35(2):265–270. [PubMed] [Google Scholar]
  31. Rautaharju P. M., Warren J. W., Jain U., Wolf H. K., Nielsen C. L. Cardiac infarction injury score: an electrocardiographic coding scheme for ischemic heart disease. Circulation. 1981 Aug;64(2):249–256. doi: 10.1161/01.cir.64.2.249. [DOI] [PubMed] [Google Scholar]
  32. Rosamond W. D., Folsom A. R., Chambless L. E., Wang C. H., McGovern P. G., Howard G., Copper L. S., Shahar E. Stroke incidence and survival among middle-aged adults: 9-year follow-up of the Atherosclerosis Risk in Communities (ARIC) cohort. Stroke. 1999 Apr;30(4):736–743. doi: 10.1161/01.str.30.4.736. [DOI] [PubMed] [Google Scholar]
  33. Saito I., Folsom A. R., Brancati F. L., Duncan B. B., Chambless L. E., McGovern P. G. Nontraditional risk factors for coronary heart disease incidence among persons with diabetes: the Atherosclerosis Risk in Communities (ARIC) Study. Ann Intern Med. 2000 Jul 18;133(2):81–91. doi: 10.7326/0003-4819-133-2-200007180-00007. [DOI] [PubMed] [Google Scholar]
  34. Schonfeld G., Lees R. S., George P. K., Pfleger B. Assay of total plasma apolipoprotein B concentration in human subjects. J Clin Invest. 1974 May;53(5):1458–1467. doi: 10.1172/JCI107694. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Schonfeld G., Pfleger B. The structure of human high density lipoprotein and the levels of apolipoprotein A-I in plasma as determined by radioimmunoassay. J Clin Invest. 1974 Aug;54(2):236–246. doi: 10.1172/JCI107758. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Siedel J., Hägele E. O., Ziegenhorn J., Wahlefeld A. W. Reagent for the enzymatic determination of serum total cholesterol with improved lipolytic efficiency. Clin Chem. 1983 Jun;29(6):1075–1080. [PubMed] [Google Scholar]
  37. Stamler J., Vaccaro O., Neaton J. D., Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993 Feb;16(2):434–444. doi: 10.2337/diacare.16.2.434. [DOI] [PubMed] [Google Scholar]
  38. Standl E., Balletshofer B., Dahl B., Weichenhain B., Stiegler H., Hörmann A., Holle R. Predictors of 10-year macrovascular and overall mortality in patients with NIDDM: the Munich General Practitioner Project. Diabetologia. 1996 Dec;39(12):1540–1545. doi: 10.1007/s001250050612. [DOI] [PubMed] [Google Scholar]
  39. Stehouwer C. D., Gall M. A., Hougaard P., Jakobs C., Parving H. H. Plasma homocysteine concentration predicts mortality in non-insulin-dependent diabetic patients with and without albuminuria. Kidney Int. 1999 Jan;55(1):308–314. doi: 10.1046/j.1523-1755.1999.00256.x. [DOI] [PubMed] [Google Scholar]
  40. Stehouwer C. D., Nauta J. J., Zeldenrust G. C., Hackeng W. H., Donker A. J., den Ottolander G. J. Urinary albumin excretion, cardiovascular disease, and endothelial dysfunction in non-insulin-dependent diabetes mellitus. Lancet. 1992 Aug 8;340(8815):319–323. doi: 10.1016/0140-6736(92)91401-s. [DOI] [PubMed] [Google Scholar]
  41. The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators. Am J Epidemiol. 1989 Apr;129(4):687–702. [PubMed] [Google Scholar]
  42. Turner R. C., Millns H., Neil H. A., Stratton I. M., Manley S. E., Matthews D. R., Holman R. R. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23) BMJ. 1998 Mar 14;316(7134):823–828. doi: 10.1136/bmj.316.7134.823. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. White A. D., Folsom A. R., Chambless L. E., Sharret A. R., Yang K., Conwill D., Higgins M., Williams O. D., Tyroler H. A. Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) Study: methods and initial two years' experience. J Clin Epidemiol. 1996 Feb;49(2):223–233. doi: 10.1016/0895-4356(95)00041-0. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES