RESUMO
OBJECTIVE: Primary prevention of Coronary Heart Disease (CHD) in diabetic patients should be based on absolute CHD risk calculation. This study was aimed to determine the levels of 10-year CHD risk in Caribbean type 2 diabetic patients using the diabetes specific United Kingdom Prospective Diabetes Study (UKPDS) risk engine calculator. SUBJECTS AND METHODS: Three hundred and twenty-five (106 males, 219 females) type 2 diabetic patients resident in two Caribbean Islands of Tobago and Trinidad met the UKPDS risk engine inclusion criteria. Records of their sex, age, ethnicity, smoking habit, diabetes duration, systolic blood pressure, total cholesterol, HDL-cholesterol and glycated haemoglobin were entered into the UKPDS risk engine calculator programme and the absolute 10-year CHD and stroke risk levels were computed. The 10-year CHD and stroke risks were statistically stratified into <15%, 15-30% and >30% CHD risk levels and differences between patients of African and Asian-Indian origin were compared. RESULTS: In comparison with patients in Tobago, type 2 diabetic patients in Trinidad, irrespective of gender, had higher proportion of 10-year CHD risk (10.4 vs. 23.6%, P<0.001) whereas the overall 10-year stroke risk prediction was higher in patients resident in Tobago (16.9 vs. 11.4%, P<0.001). Ethnicity-based analysis revealed that irrespective of gender, higher proportion of patients of Indian origin scored >30% of absolute 10-year CHD risk compared with patients of African descent (3.2 vs. 28.2%, P<0.001). CONCLUSIONS: The results of the study identified diabetic patients resident in Trinidad and patients of Indian origin as the most vulnerable groups for CHD. These groups of diabetic patients should have priority in primary or secondary prevention of coronary heart disease.
Assuntos
Doença das Coronárias/etnologia , Diabetes Mellitus Tipo 2/etnologia , Angiopatias Diabéticas/etnologia , Idoso , Doença das Coronárias/tratamento farmacológico , Doença das Coronárias/prevenção & controle , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Prevenção Primária , Medição de Risco , Prevenção Secundária , Acidente Vascular Cerebral/etnologia , Trinidad e Tobago/epidemiologiaRESUMO
Ethnicity has been shown to be associated with micro- and macrovascular complications of diabetes in European and North American populations. We analyzed the contribution of ethnicity to the prevalence of micro- and macrovascular complications in Brazilian subjects with type 2 diabetes attending the national public health system. Data from 1810 subjects with type 2 diabetes (1512 whites and 298 blacks) were analyzed cross-sectionally. The rates of ischemic heart disease, peripheral vascular disease, stroke, distal sensory neuropathy, and diabetic retinopathy were assessed according to self-reported ethnicity using multiple logistic regression models. Compared to whites, black subjects [odds ratio = 1.72 (95%CI = 1.14-2.6)] were more likely to have ischemic heart disease when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, smoking habit, and serum creatinine. Blacks were also more likely to have end-stage renal disease [3.2 (1.7-6.0)] and proliferative diabetic retinopathy [1.9 (1.1-3.2)] compared to whites when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, and smoking habit. The rates of peripheral vascular disease, stroke and distal sensory neuropathy did not differ between groups. The higher rates of ischemic heart disease, end-stage renal disease and proliferative diabetic retinopathy in black rather than in white Brazilians were not explained by differences in conventional risk factors. Identifying which aspects of ethnicity confer a higher risk for these complications in black patients is crucial in order to understand why such differences exist and to develop more effective strategies to reduce the onset and progression of these complications.
Assuntos
População Negra/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Idoso , Brasil/epidemiologia , Brasil/etnologia , Doença Crônica , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Angiopatias Diabéticas/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
Ethnicity has been shown to be associated with micro- and macrovascular complications of diabetes in European and North American populations. We analyzed the contribution of ethnicity to the prevalence of micro- and macrovascular complications in Brazilian subjects with type 2 diabetes attending the national public health system. Data from 1810 subjects with type 2 diabetes (1512 whites and 298 blacks) were analyzed cross-sectionally. The rates of ischemic heart disease, peripheral vascular disease, stroke, distal sensory neuropathy, and diabetic retinopathy were assessed according to self-reported ethnicity using multiple logistic regression models. Compared to whites, black subjects [odds ratio = 1.72 (95 percentCI = 1.14-2.6)] were more likely to have ischemic heart disease when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, smoking habit, and serum creatinine. Blacks were also more likely to have end-stage renal disease [3.2 (1.7-6.0)] and proliferative diabetic retinopathy [1.9 (1.1-3.2)] compared to whites when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, and smoking habit. The rates of peripheral vascular disease, stroke and distal sensory neuropathy did not differ between groups. The higher rates of ischemic heart disease, end-stage renal disease and proliferative diabetic retinopathy in black rather than in white Brazilians were not explained by differences in conventional risk factors. Identifying which aspects of ethnicity confer a higher risk for these complications in black patients is crucial in order to understand why such differences exist and to develop more effective strategies to reduce the onset and progression of these complications.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Negra/estatística & dados numéricos , /epidemiologia , Angiopatias Diabéticas/epidemiologia , Brasil/epidemiologia , Brasil/etnologia , Doença Crônica , Estudos Transversais , /complicações , /etnologia , Angiopatias Diabéticas/etnologia , PrevalênciaRESUMO
OBJECTIVE: To examine social, demographic and health factors associated with cognitive decline over a seven-year period among older Mexican Americans with diabetes. METHODS: A population-based sample of 808 noninstitutionalized Mexican Americans aged >65 years with diabetes who had a Mini-Mental State Examination (MMSE) >17 at baseline from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE). Measurements included sociodemographics, diabetic treatment received (oral hypoglycemic or insulin), self-reported medical conditions, self-reported diabetes-related complications, high depressive symptoms and ADL limitations. RESULTS: The mean MMSE score at baseline was 25.3 + (SD=3.7). The rate of decline in cognitive function (MMSE) during the follow-up period was 0.37 point per year. Using general linear mixed models, we found that being male, and having high depressive symptoms and diabetic complications (kidney impairment, circulation problems or limb amputation) were factors significantly associated with greater declines in MMSE score over time. CONCLUSION: Circulation problems, kidney impairment and depression are the major factors associated with cognitive decline in older Mexican Americans with diabetes.
Assuntos
Transtornos Cognitivos/epidemiologia , Diabetes Mellitus/etnologia , Americanos Mexicanos , Idoso , Transtornos Cognitivos/etnologia , Comorbidade , Depressão/epidemiologia , Depressão/etnologia , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/etnologia , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/etnologia , Feminino , Humanos , MasculinoRESUMO
AIM: The morbidity and mortality from cardiovascular complications in diabetes reputedly differ with ethnicity. We have evaluated the prevalence of hypertension and vascular complications amongst Afro-Caribbean (AC), Caucasian (C) and Indo-Asian (IA) ethnic subgroups of a district's diabetes population to estimate the impact of ethnic origin as an independent risk variable. METHODS: Of the 6485 registered adult individuals, 6047 had ethnic data available and belonged to one of the three ethnic groups described (AC 9%, C 70% and IA 21%). Statistical analyses were performed using spss version 11.5. RESULTS: Results are presented as mean +/- s.d. or percentage. IAs were younger (AC 63 +/- 13, C 61 +/- 15 and IA 57 +/- 13 years), were less obese (body mass index 30 +/- 8, 29 +/- 9, 28 +/- 6 kg/cm2) and had lower systolic blood pressure (155 +/- 25, 149 +/- 24, 147 +/- 24 mmHg) and lower prevalence of hypertension (82%, 74% and 68%) compared with C, who had lower values than AC (all p < 0.01). Relative to C group, the AC group had higher prevalence of hypertension and microvascular complications but lower macrovascular disease burden, while the IA group had lower hypertension and macrovascular complications but with comparable microvascular disease burden [microvascular (51%, 44% and 46%; p < 0.01) and macrovascular (33%, 40% and 32%; p < 0.001)]. On logistic regression, this effect of ethnic origin on diabetic complications was found to be significant and independent of other risk variables. CONCLUSION: Hypertension and diabetic complication rates were different amongst ethnic subgroups. On logistic regression, it was found that the difference in distribution of age and diabetes duration largely accounted for this difference, although ethnic origin remained an independent risk factor.
Assuntos
Angiopatias Diabéticas/etnologia , Hipertensão/etnologia , Adulto , Idoso , Ásia/etnologia , Distribuição de Qui-Quadrado , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Índias Ocidentais/etnologia , População Branca/etnologiaRESUMO
BACKGROUND: This study examined whether cardiorespiratory fitness is a risk factor for cardiovascular disease, myocardial infarction, and all-cause mortality in a low- to middle-income Trinidadian community of African, South Asian Indian, and European origin. Those of Indian descent have a distinctively high rate of myocardial infarction. METHODS: The St James Study is a prospective total community survey located in Port-of-Spain, Trinidad, West Indies. A random sample of 626 men aged 35-69 years, without angina of effort, previous myocardial infarction, partial or complete atrio-ventricular conduction defect, complete heart block, or exercise-induced asthma, was used for the assessment of cardiorespiratory fitness by cycle ergometry. Surveillance for morbidity and mortality was maintained for an average of 7.3 years. RESULTS: When the subjects were grouped into those with an age- and fat-free mass-adjusted peak oxygen uptake above and below the mean of 60.4 mmol/min (1.34 l/min), the hazard ratios (below/above) (95% confidence interval) for all-cause mortality, cardiovascular disease incidence, and incidence of myocardial infarction, after allowance for conventional cardiovascular risk factors, were 2.08 (1.23-3.52), 2.13 (1.22-3.69), and 2.36 (0.84-6.67), respectively. For those unable to achieve a level of work requiring an oxygen uptake of 67 mmol/min (1.5 l/min) during progressive exercise, the respective hazard ratios were 3.49 (1.57-7.76), 2.29 (1.21-4.33), and 5.45 (1.22-24.34). Indian ethnicity remained a predictor of myocardial infarction after allowance for cardiorespiratory performance. CONCLUSION: Low cardiorespiratory fitness is a risk factor for cardiovascular disease morbidity and mortality in the low- to middle-income developing community of Trinidad.
Assuntos
Adulto , Pessoa de Meia-Idade , Idoso , Humanos , Masculino , População Negra/estatística & dados numéricos , Antropometria , Pressão Sanguínea , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Angiopatias Diabéticas/etnologia , Angiopatias Diabéticas/fisiopatologia , Eletrocardiografia , Infarto do Miocárdio/etnologia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Fatores de Risco , Trinidad e TobagoRESUMO
BACKGROUND: This study examined whether cardiorespiratory fitness is a risk factor for cardiovascular disease, myocardial infarction, and all-cause mortality in a low- to middle-income Trinidadian community of African, South Asian Indian, and European origin. Those of Indian descent have a distinctively high rate of myocardial infarction. METHODS: The St James Study is a prospective total community survey located in Port-of-Spain, Trinidad, West Indies. A random sample of 626 men aged 35-69 years, without angina of effort, previous myocardial infarction, partial or complete atrio-ventricular conduction defect, complete heart block, or exercise-induced asthma, was used for the assessment of cardiorespiratory fitness by cycle ergometry. Surveillance for morbidity and mortality was maintained for an average of 7.3 years. RESULTS: When the subjects were grouped into those with an age- and fat-free mass-adjusted peak oxygen uptake above and below the mean of 60.4 mmol/min (1.34 l/min), the hazard ratios (below/above) (95% confidence interval) for all-cause mortality, cardiovascular disease incidence, and incidence of myocardial infarction, after allowance for conventional cardiovascular risk factors, were 2.08 (1.23-3.52), 2.13 (1.22-3.69), and 2.36 (0.84-6.67), respectively. For those unable to achieve a level of work requiring an oxygen uptake of 67 mmol/min (1.5 l/min) during progressive exercise, the respective hazard ratios were 3.49 (1.57-7.76), 2.29 (1.21-4.33), and 5.45 (1.22-24.34). Indian ethnicity remained a predictor of myocardial infarction after allowance for cardiorespiratory performance. CONCLUSION: Low cardiorespiratory fitness is a risk factor for cardiovascular disease morbidity and mortality in the low- to middle-income developing community of Trinidad.
Assuntos
Doenças Cardiovasculares/etnologia , Causas de Morte , Aptidão Física , Adulto , Idoso , Antropometria , População Negra/estatística & dados numéricos , Pressão Sanguínea , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Angiopatias Diabéticas/etnologia , Angiopatias Diabéticas/fisiopatologia , Eletrocardiografia , Teste de Esforço/métodos , Inquéritos Epidemiológicos , Humanos , Índia/etnologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etnologia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Consumo de Oxigênio , Fatores de Risco , Trinidad e Tobago/epidemiologia , População Branca/estatística & dados numéricosRESUMO
OBJECTIVE: The aim of this study was to examine the relationship between inconsistency in use of diabetes drugs and risk of renal, eye, and circulation problems and death over a 7-year period in community-dwelling older Mexican Americans. RESEARCH DESIGN AND METHODS: Data are from the four waves of the Hispanic Established Population for the Epidemiologic Study of the Elderly. In-home interviewers assessed consistency in use of diabetes medications among 908 diabetic Mexican Americans, aged >or=65 years. Diabetes and complications were by self-report. Subjects with poor consistency in use of medication were those who, at any time during the 7-year follow-up, discontinued or inconsistently used their diabetes medications and those who had no diabetic medications at home despite self-report of taking medicine for diabetes. RESULTS: Thirty-six percent of our sample were inconsistent with diabetes medication usage. Older age and lack of supplemental health insurance were significantly associated with inconsistency of use of medication. In a multivariate logistic regression model, subjects with poor consistency in use of medication were more likely to report kidney problems (odds ratio [OR] 1.59; 95% CI 1.13-2.23; P = 0.008) at follow-up compared with those with good consistency, after controlling for age, sex, medication type, duration of diabetes, education, income, marital status, language of interview, insurance status, cognitive function, presence of depressive symptoms, activities of daily living, and instrumental activities of daily living. In Cox regression models, poor consistency with diabetic medication was also associated with increased all-cause mortality (hazard ratio [HR] 1.43; 95% CI 1.13-1.82; P = 0.003) and diabetes-related deaths (1.66; 1.20-2.30; P = 0.002) over a 7-year period after adjusting for relevant confounders. CONCLUSIONS: Inconsistent use of diabetic medication was associated with an increased risk of kidney problems and deaths over a 7-year period in older Mexican Americans.
Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/mortalidade , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/mortalidade , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Americanos Mexicanos/estatística & dados numéricos , Idoso , Cognição , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 2/etnologia , Angiopatias Diabéticas/etnologia , Angiopatias Diabéticas/mortalidade , Nefropatias Diabéticas/etnologia , Nefropatias Diabéticas/mortalidade , Retinopatia Diabética/etnologia , Retinopatia Diabética/mortalidade , Feminino , Humanos , Masculino , Cooperação do Paciente , Prevalência , AutoadministraçãoRESUMO
This study was designed to examine the association of sociodemographic and health-related factors with the development of diabetic complications in older Mexican Americans. Data came from the baseline interview of the Hispanic Established Population for the Epidemiological Study of the Elderly (EPESE), conducted in 1993-1994, a population-based study of 3,050 Mexican Americans aged 65 and older from 5 southwestern states. A total of 690 subjects (23%) reported having been diagnosed with diabetes. Of these, 412 (60%) reported having one or more diabetic complications. Multiple logistic regression analysis found that respondents with less than 12 years of education were more likely to report diabetic complications than those with higher school education. Having diabetes for over 15 years, and having had a stroke or a heart attack were also associated with elevated rates of complications. Circulation problems were the most common complication reported by 280 (40%) respondents, followed by eye problems (38%), kidney problems (14%) and amputations (8%). Special attention should be given to sociodemographic and health-related factors influencing the health of older Mexican Americans. Identification of these factors will help physicians better control the disease to prevent complications.
Assuntos
Angiopatias Diabéticas/etnologia , Americanos Mexicanos , Idoso , Idoso de 80 Anos ou mais , Retinopatia Diabética/etnologia , Escolaridade , Feminino , Cardiopatias/etnologia , Humanos , Hipertensão/etnologia , Modelos Logísticos , Masculino , Acidente Vascular Cerebral/etnologia , Fatores de TempoRESUMO
The anticipated global epidemic of diabetes, largely as a consequence of increased rates of obesity, will particularly impact on people of South Asian and African Caribbean descent, two populations at elevated risk of insulin resistance. This article contrasts the consequent heightened risk of heart disease on the one hand in South Asians, and the paradoxical protection from heart disease in African Caribbeans on the other. Protection from the hypertriglyceridaemic effects of insulin resistance is likely to account for much of the African Caribbean paradox, although the mechanisms remain unclear. The growing evidence that insulin resistance is commonly observed in people with Type 1 diabetes, as well as those with Type 2 diabetes, and that features of insulin resistance may play a crucial role in the development of microvascular, as well as macrovascular complications, is also discussed. This indicates novel targets for the prevention and treatment of diabetes complications.