Risk factors for cardiovascular disease in a diabetic population.

A study of the associations with cardiovascular disease (CVD) was made in subjects attending the Diabetic Clinic at Royal Perth Hospital. The variables examined were sex, age at time of study, age of onset of diabetes, duration of diabetes, mode of treatment, control (as assessed by fasting and post-prandial plasma glucose concentrations and glycosylated hemoglobin concentration), insulin levels in subjects not on insulin, obesity, blood pressure, total- and high-density lipoprotein and triglyceride concentrations, and smoking habit. CVD was diagnosed on the basis of (a) past history of myocardial infarction, (b) definite angina, (c) diagnostic ECG abnormality, and (d) cardiomegaly. A multiple logistic regression model identified the variables showing independent, significant associations with CVD as age, high-density lipoprotein cholesterol, diastolic blood pressure, an interaction between smoking and age and an interaction between treatment mode and blood pressure. As in the population generally, high-density lipoprotein cholesterol is the lipid variable showing the most significant association with prevalence of cardiovascular disease. Smoking is associated with a substantially increased risk of CVD in diabetics up to the age of about 70 yr. The use of oral hypoglycemic agents is associated with a lower prevalence of CVD in normotensive subjects, but with an increased risk in those who have systolic hypertension.