Diabetes and modifiable risk factors for cardiovascular disease: the prospective Million Women Study

• Published in: European journal of epidemiology Vol. 23; no. 12; pp. 793 - 799
• Main Authors: Spencer, Elizabeth A, Pirie, Kirstin L, Stevens, Richard J, Beral, Valerie, Brown, Anna, Liu, Bette, Green, Jane, Reeves, Gillian K
• Format: Journal Article
• Language: English
• Published: Dordrecht Dordrecht : Springer Netherlands 01.12.2008; Springer; Springer Netherlands; Springer Nature B.V
• Subjects: Age Distribution; Aged; Biological and medical sciences; Body mass index; Cardiology; Cardiovascular Disease; Cardiovascular Diseases; Coronary artery disease; Coronary Disease - complications; Coronary Disease - epidemiology; Diabetes; Diabetes Complications - epidemiology; Diabetes Mellitus - drug therapy; Diabetes Mellitus - epidemiology; Diabetes. Impaired glucose tolerance; Diabetic angiopathies; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Health behavior; Hospital admissions; Humans; Hypoglycemic Agents - therapeutic use; Incidence; Infectious Diseases; Insulin; Insulin - therapeutic use; Life Style; Medical Record Linkage; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous; Oncology; Proportional Hazards Models; Prospective Studies; Public Health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Smoking; Smoking - adverse effects; Smoking - epidemiology; Stroke - complications; Stroke - epidemiology; Strokes; Surveys and Questionnaires; Tobacco, tobacco smoking; Toxicology; Type 1 diabetes mellitus; Type 2 diabetes mellitus; United Kingdom - epidemiology; Vascular diseases; Womens health; British Isles; Prospective; Body mass index; Diabetes; Physical activity; Cardiovascular; Smoking; Endocrinopathy; Physical exercise; Human; Diabetes mellitus; Tobacco smoking; Cardiovascular disease; Epidemiology; Tobacco; Risk factor; Female; Cardiovascular, Diabetes, Prospective; Circulatory system; Woman; Physical activity, Smoking; Public health
• ISSN: 0393-2990; 1573-7284
• DOI: 10.1007/s10654-008-9298-3

To compare the effect of potentially modifiable lifestyle factors on the incidence of vascular disease in women with and without diabetes. In 1996-2001 over one million middle-aged women in the UK joined a prospective study, providing medical history, lifestyle and socio-demographic information. All participants were followed for hospital admissions and deaths using electronic record-linkage. Adjusted relative risks (RRs) and incidence rates were calculated to compare the incidence of coronary heart disease and stroke in women with and without diabetes and by lifestyle factors. At recruitment 25,915 women (2.1% of 1,242,338) reported current treatment for diabetes. During a mean follow-up of 6.1 years per woman, 21,928 had a first hospital admission or death from coronary heart disease (RR for women with versus without diabetes = 3.30, 95% CI 3.14-3.47) and 7,087 had a first stroke (RR = 2.47, 95% CI 2.24-2.74). Adjusted incidence rates of these conditions in women with diabetes increased with duration of diabetes, obesity, inactivity and smoking. The 5-year adjusted incidence rates for cardiovascular disease were 4.6 (95% CI 4.4-4.9) per 100 women aged 50-69 in non-smokers with diabetes, 5.9 (95% CI 4.6-7.6) in smokers with diabetes not using insulin and 11.0 (95% CI 8.3-14.7) in smokers with diabetes using insulin. Non-smoking women with diabetes who were not overweight or inactive still had threefold increased rate for coronary disease or stroke compared with women without diabetes. Of the modifiable factors examined in middle aged women with diabetes, smoking causes the greatest increase in cardiovascular disease, especially in those with insulin treated diabetes.