Screen-detected diabetes, hypertension and hypercholesterolemia as predictors of cardiovascular mortality in five populations of Asian origin: the DECODA study

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Abstract

Background

The World Health Organization (WHO) predicts that the Asia Pacific region will experience an increase in cardiovascular disease (CVD) as a result of demographic changes and an increasing prevalence of diabetes. The aims of this study were to assess the predictive value of glucose tolerance status as a risk factor for CVD and identify a high-risk group for fatal CVD in population-based studies of Asians.

Design

A meta-analysis of five prospective cohort studies of Japanese and Asian Indian origin from five countries.

Methods

A total of 6573 subjects without a history of CVD from five prospective studies were followed for 5–10 years. Diabetes at baseline was diagnosed according to 1999 WHO criteria. Hazard ratios for death from CVD were estimated using a Cox proportional hazard model, adjusting for glucose tolerance status together with established risk factors for CVD.

Results

The meta-analysis showed that the overall hazard ratios (95% confidence interval) for CVD mortality corresponding to the presence of screen-detected diabetes, hypertension and hypercholesteremia were 3.42 (2.23–5.23), 1.57 (1.10–2.24) and 1.49 (1.05–2.10), respectively. Stratified multivariate analysis of the pooled data showed that subjects with screen-detected diabetes in the presence of hypertension or hypercholesteremia had the highest risk of CVD in individuals without previous CVD or diabetes. Subjects with screen-detected diabetes in the presence of hypertension or hypercholesteremia comprised 78% of CVD deaths that occurred in all subjects with screen-detected diabetes.

Conclusions

The early detection of undiagnosed diabetes in hypertension or hypercholesteremia may have clinical and public health implications for the primary prevention of rapidly increasing diabetes-related atherosclerotic CVD in Asian populations.

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