RESUMEN
BACKGROUND: The long-term consequences of autoimmune diabetes in adults (AIDA) are largely unexplored. OBJECTIVE: To investigate the risk of myocardial infarction (MI) in AIDA compared to type 2 diabetes, taking into consideration the effects of socio-economic and lifestyle factors, the metabolic syndrome and glycaemic control. METHODS: A total of 62 995 participants including 207 individuals with AIDA (onset ≥35 years and anti-GAD positive) and 2322 individuals with type 2 diabetes (onset ≥35 years and anti-GAD negative), from the population-based Norwegian HUNT study, were followed for a first MI during the period 1995-2008. We identified 2614 MIs by hospital records or the National Cause of Death Registry. Cox proportional hazard models were used to estimate the risk of MI by diabetes subgroups after adjustment for age and socio-economic and lifestyle factors. RESULTS: AIDA amongst women was associated with a nearly fourfold increased risk of MI [hazard ratio (HR) 3.63, 95% confidence interval (CI) 2.21-5.96) compared to nondiabetic participants, whereas no excess risk was found in men with AIDA (HR 1.30, 95% CI 0.70-2.52). By contrast, type 2 diabetes was associated with an increased MI risk in both men (HR 1.92, 95% CI 1.62-2.26) and women (HR 2.39, 95% CI 1.98-2.89). The metabolic profile was more favourable in patients with AIDA than in those with type 2 diabetes, but glycaemic control was worse. Multivariable models and sensitivity analyses suggest that these results were robust. CONCLUSIONS: Women with AIDA were more likely to develop MI, compared to men with AIDA and both men and women with type 2 diabetes. Further investigations are warranted to confirm this gender difference.
Asunto(s)
Enfermedades Autoinmunes/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Infarto del Miocardio/complicaciones , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/inmunología , Femenino , Estudios de Seguimiento , Humanos , Estilo de Vida , Masculino , Síndrome Metabólico/complicaciones , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Factores Sexuales , Factores SocioeconómicosRESUMEN
OBJECTIVES: To delineate the association of weight with cardiovascular health throughout adulthood. METHODS: We conducted a population-based prospective cohort study of 26 097 community-dwelling individuals who were followed for 11.4 years with measurements of cardiovascular risk factors and common chronic disorders. Body weight and height were directly measured at baseline in 1995-1997 as they had been 10 and 30 years prior to baseline. From these measurements, we estimated average body mass index (BMI) over time and calculated weight change. RESULTS: The association of average BMI with acute myocardial infarction (AMI) became weaker with adjustment for the most recent BMI measurement, whilst this adjustment had a more limited effect on associations with heart failure (HF) risk. For example, the multi-adjusted hazard ratios for AMI in a comparison of individuals with average BMI until baseline ≥35 kg m(-2) and between 18.5 and 22.4 kg m(-2) decreased from 1.75 [95% confidence interval (CI) 1.04-2.95] to 1.32 (0.73-2.40). The corresponding numbers for HF were 3.12 (1.85-5.27) and 2.95 (1.53-5.71), respectively. The associations between weight change and risk of AMI and HF were U-shaped, with stable weight showing the lowest risk. CONCLUSION: Sustained overweight or obesity over time is associated with increased risk of HF, even after adjustment for the most recent BMI. For AMI risk, the most recent BMI appears to be the most important. Weight change also increases risks for both outcomes beyond the effects of BMI. Our results suggest that a global epidemic of obesity is likely to increase the incidence of HF, even if BMI in middle age can be controlled.
Asunto(s)
Peso Corporal , Insuficiencia Cardíaca/complicaciones , Infarto del Miocardio/complicaciones , Sobrepeso/complicaciones , Estatura , Índice de Masa Corporal , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de RiesgoRESUMEN
AIMS: Compelling evidence suggests that light-to-moderate alcohol consumption is associated with a reduced risk of acute myocardial infarction (AMI), but several issues from previous studies remain to be addressed. The aim of this study was to investigate some of these key issues related to the association between alcohol consumption and AMI risk, including the strength and shape of the association in a low-drinking setting, the roles of quantity, frequency and beverage type, the importance of confounding by medical and psychiatric conditions, and the lack of prospective data on previous drinking. METHODS: A population-based prospective cohort study of 58 827 community-dwelling individuals followed for 11.6 years was conducted. We assessed the quantity and frequency of consumption of beer, wine and spirits at baseline in 1995-1997 and the frequency of alcohol intake approximately 10 years earlier. RESULTS: A total of 2966 study participants had an AMI during the follow-up period. Light-to-moderate alcohol consumption was inversely and linearly associated with AMI risk. After adjusting for major cardiovascular disease risk factors, the hazard ratio for a one-drink increment in daily consumption was 0.72 (95% confidence interval 0.62-0.86). Accounting for former drinking or comorbidities had almost no effect on the association. Frequency of alcohol consumption was more strongly associated with lower AMI risk than overall quantity consumed. CONCLUSIONS: Light-to-moderate alcohol consumption was linearly associated with a decreased risk of AMI in a population in which abstaining from alcohol is not socially stigmatized. Our results suggest that frequent alcohol consumption is most cardioprotective and that this association is not driven by misclassification of former drinkers.