Introduction: Diabetes mellitus (DM) is an important risk factor for coronary heart disease (CHD) and has been considered to be a relatively stronger predictor for CHD in women than men. Angina pectoris (AP) can be a debilitating consequence of CHD. The temporal relationship between pre-diabetes (pre-DM), DM and AP among older adults without CHD at baseline has not been previously characterized. We investigated the relation of these factors, and other predictors of incident AP, among older adults.
Methods: We examined in adults aged ≥65 years from the Cardiovascular Health Study, a prospective study of cardiovascular disease, incident AP event rates by sex and diabetes status. Cox regression, with calculated hazard ratios (HR), determined the risk of incident AP according to presence of pre-DM or DM, compared to neither condition, along with other risk factors, as predictors of incident AP over 15 years of follow up.
Results: Among 3052 adults (mean age 71.0 ± 5.1 years, 62.2% female) without CHD at baseline, 41.5% had pre-DM, 11.5% had DM, and 674 (22.1%) had incident AP. Incident AP event rates per 1000 person-years in those with neither condition, pre-DM, and DM were 5.0, 5.5, and 6.0 in women and 7.7, 9.0, and 10.6 in men, respectively. DM and male gender were key predictors of incident AP with adjusted HRs of 1.37 (p=0.01) and 1.40 (p=0.0008), respectively, as were age, lower HDL, higher waist circumference, higher systolic blood pressure (BP), lower diastolic BP, and aspirin use (Table). Pre-DM predicted increased risk of AP among men, adjusted HR 1.34 (p=0.03), but not in women, adjusted HR 1.00 (p=0.99). DM predicted a greater risk of AP among men, adjusted HR 1.71 (p=0.0034), but not in women, adjusted HR 1.14 (p=0.5026).
Conclusions: Prevalent DM is associated with an increased risk of incident AP independent of other CHD risk factors in older adults. Pre-DM and DM status were more strongly related to incident AP among men vs. women.