Family history of diabetes and risk of atherosclerotic cardiovascular disease in Korean men and women

The effect of obesity phenotype changes on cardiovascular outcomes in adults older than 40 years in the prospective cohort of the Tehran lipids and glucose study (TLGS): joint model of longitudinal and time-to-event data

BACKGROUND

Obesity is a worldwide health concern with serious clinical effects, including myocardial infarction (MI), stroke, cardiovascular diseases (CVDs), and all-cause mortality. The present study aimed to assess the association of obesity phenotypes and different CVDs and mortality in males and females by simultaneously considering the longitudinal and survival time data.

METHODS

In the Tehran Lipid and Glucose Study (TLGS), participants older than three years were selected by a multi-stage random cluster sampling method and followed for about 19 years. In the current study, individuals aged over 40 years without a medical history of CVD, stroke, MI, and coronary heart disease were included. Exclusions comprised those undergoing treatment for CVD and those with more than 30% missing information or incomplete data. Joint modeling of longitudinal binary outcome and survival time data was applied to assess the dependency and the association between the changes in obesity phenotypes and time to occurrence of CVD, MI, stroke, and CVD mortality. To account for any potential sex-related confounding effect on the association between the obesity phenotypes and CVD outcomes, sex-specific analysis was carried out. The analysis was performed using packages (JMbayes2) of R software (version 4.2.1).

RESULTS

Overall, 6350 adults above 40 years were included. In the joint modeling of CVD outcome among males, literates and participants with a family history of diabetes were at lower risk of CVD compared to illiterates and those with no family history of diabetes in the Bayesian Cox model. Current smokers were at higher risk of CVD compared to non-smokers. In a logistic mixed effects model, odds of obesity phenotype was higher among participants with low physical activity, family history of diabetes and older age compared to males with high physical activity, no family history of diabetes and younger age. In females, based on the results of the Bayesian Cox model, participants with family history of diabetes, family history of CVD, abnormal obesity phenotype and past smokers had a higher risk of CVD compared to those with no history of diabetes, CVD and nonsmokers. In the obesity varying model, odds of obesity phenotype was higher among females with history of diabetes and older age compared to those with no history of diabetes and who were younger. There was no significant variable associated with MI among males in the Bayesian Cox model. Odds of obesity phenotype was higher in males with low physical activity compared to those with high physical activity in the obesity varying model, whereas current smokers were at lower odds of obesity phenotype than nonsmokers. In females, risk of MI was higher among those with family history of diabetes compared to those with no history of diabetes in the Bayesian Cox model. In the logistic mixed effects model, a direct and significant association was found between age and obesity phenotype. In males, participants with history of diabetes, abnormal obesity phenotype and older age were at higher risk of stroke in the Bayesian Cox model compared to males with no history of diabetes, normal obesity phenotype and younger persons. In the obesity varying model, odds of obesity phenotype was higher in males with low physical activity, family history of diabetes and older age compared to those with high physical activity, no family history of diabetes and who were younger. Smokers had a lower odds of obesity phenotype than nonsmokers. In females, past smokers and those with family history of diabetes were at higher risk of stroke compared to nonsmokers and females with no history of diabetes in the Bayesian Cox model. In the obesity varying model, females with family history of diabetes and older ages had a higher odds of obesity phenotype compared to those with no family history of diabetes and who were younger. Among males, risk of CVD mortality was lower in past smokers compared to nonsmokers in the survival model. A direct and significant association was found between age and CVD mortality. Odds of obesity phenotype was higher in males with a history of diabetes than in those with no family history of diabetes in the logistic mixed effects model.

CONCLUSIONS

It seems that modifications to metabolic disorders may have an impact on the heightened incidence of CVDs. Based on this, males with obesity and any type of metabolic disorder had a higher risk of CVD, stroke and CVD mortality (excluding MI) compared to those with a normal body mass index (BMI) and no metabolic disorders. Females with obesity and any type of metabolic disorder were at higher risk of CVD(, MI and stroke compared to those with a normal BMI and no metabolic disorders suggesting that obesity and metabolic disorders are related. Due to its synergistic effect on high blood pressure, metabolic disorders raise the risk of CVD.

Cardiovascular age of workers with different employment categories

INTRODUCTION

We compared the cardiovascular age (an indicator of cardiovascular disease risk) in workers with different employment status after adjustment for demographic and socioeconomic factors.

METHODS

This cross-sectional study used data collected from 2007 to 2017 for the Korea National Health and Nutrition Examination Survey (KNHANES). Study participants were placed into different employment categories based on employment status and work schedule: regular full-time, regular part-time, temporary full-time, temporary part-time, daily full-time, and daily part-time.

RESULTS

Analysis of women indicated that regular part-time, temporary full-time, temporary part-time, daily full-time, and daily part-time workers were more likely to have an older cardiovascular age (OR = 1.180, 1.238, 1.297, 1.493, and 1.408, respectively) after adjustment for age, marriage, education, income, residence, region, and drinking status. Analysis of men indicated employment status was unrelated to cardiovascular age.

CONCLUSION

Female nonstandard Korean workers were more likely to have an increased cardiovascular age. However, most of these workers, especially daily workers, are not currently protected by the Occupational Safety and Health Act (OSHA) of Korea. Collaboration or networking with community-based health care services in Korea is essential to better manage the health of these vulnerable female workers.

Association of familial history of diabetes or myocardial infarction and stroke with risk of cardiovascular diseases in four German cohorts

Since family history of diabetes is a very strong risk factor for type 2 diabetes, which is one of the most important risk factors for cardiovascular disease (CVD), it might be also useful to assess the risk for CVD. Therefore, we aimed to investigate the relationship between a familial (parents and siblings) history of diabetes and the risk of incident CVD. Data from four prospective German cohort studies were used: EPIC-Potsdam study (n = 26,054), CARLA study (n = 1,079), SHIP study (n = 3,974), and KORA study (n = 15,777). A multivariable-adjusted Cox regression was performed to estimate associations between familial histories of diabetes, myocardial infarction or stroke and the risk of CVD in each cohort; combined hazard ratios (HR_Meta) were derived by conducting a meta-analysis. The history of diabetes in first-degree relatives was not related to the development of CVD (HR_Meta 0.99; 95% CI 0.88–1.10). Results were similar for the single outcomes myocardial infarction (MI) (HR_Meta 1.07; 95% CI 0.92–1.23) and stroke (HR_Meta 1.00; 95% CI 0.86–1.16). In contrast, parental history of MI and stroke were associated with an increased CVD risk. Our study indicates that diabetes in the family might not be a relevant risk factor for the incidence of CVD. However, the study confirmed the relationship between a parental history of MI or stroke and the onset of CVD.

Frequency of type I and II diabetes in newly diagnosed diabetic patients: Measuring C-Peptide level

AIMS

Diabetes mellitus is a metabolic disease that manifested as hyperglycemia due to the defect in secretion or function of insulin. This study aimed was to survey about frequency type I and II diabetes in newly diagnosed diabetic patients base on c-peptide and anti-glutamate acid decarboxylase (GAD) tests.

MATERIALS & METHODS

This study was conducted as a prospective study on 70 diabetic patients aged 15-45 years old who referred to diabetes clinics in Ahvaz city during 2012-2014 and their diabetes was diagnosed for the first time, but their type of diabetes was not clinically definitive. Patients with anti-GAD positive and fasting C-peptide level of less than 0.65 were diagnosed as type I diabetes. Patients with anti-GAD negative fasting C-peptide level of greater than or equal to 0.65 were considered as type II diabetes.

RESULTS

Eighty two patients (49 males and 33 females) with a mean age of 21.64 ± 4.36 years (range 15-34) and a mean BMI of 22.05 ± 4.41 kg/m² (range 14-18) were studied. Twenty three patients (28.5%) had type I diabetes and 59 patients (71.95%) had type II diabetes. In patients with type I diabetes, the mean BMI was 24.86 ± 2.36 kg/m² and the number of patients with family history (56.22%) was higher. In type II diabetic patients, the number of women (62.71%) was higher than that of men.

CONCLUSION

Anti-GAD test can be used as a predictive test for early diagnosis of disease and screening of people with a diagnosis of diabetes based on the type of diabetes.

Association of Percentage Body Fat and Metabolic Health in Offspring of Patients with Cardiovascular Diseases

Family history was one of the major risk factors for developing adverse health outcomes such as metabolic syndrome (MetS), type 2 diabetes mellitus (DM) and hypertension (HTN). Our aim was to examine the relationship between different family histories and cardiometabolic events, including DM, stroke, myocardial infarction (MI), and HTN. Participants who attended the health examinations at the Tri-Service General Hospital from 2010 to 2016 were enrolled in the study and were categorized into four groups by representing different family history. A multivariable logistic regression model was used for the associations between various family history with the cardiometabolic events. Subjects with family history of DM were divided into quartiles by percentage body fat (PBF) to be analyzed for these adverse outcomes. In the cross-sectional analysis, subjects with family history of DM had significant association with MetS (OR = 1.34 [95%CI: 1.17-1.54]) and DM (OR = 3.03 [95%CI: 2.44-3.76]), and those with family history of HTN were positively associated with HTN (OR = 1.60 [95%CI: 1.41-1.81]). Notably, those with family history of DM in higher PBF quartiles had substantially increased association of cardiometabolic events (MetS: OR = 15.20 [95%CI: 9.87-23.39]; DM: OR = 3.35 [95%CI: 1.91-5.90]; HTN: 2.81 [95%CI: 1.84-4.29]). Individuals with family history of DM were positively associated with MetS and DM, and those with family history of HTN was associated with HTN. Family history assessment was requested especially in obese population for screening adverse health outcomes.

A decrease in serum 1,5-anhydroglucitol levels is associated with the presence of a first-degree family history of diabetes in a Chinese population with normal glucose tolerance

AIM

This study aimed to investigate alterations in HbA_1c , glycated albumin (GA) and 1,5-anhydroglucitol (1,5-AG) in Chinese first-degree relatives of individuals with diabetes (FDR) in pursuit of an index for early screening of glucose metabolism disturbance.

METHODS

A total of 467 participants (age range: 20-78 years) with normal weight and normal glucose tolerance, as determined by a 75-g oral glucose tolerance test, were enrolled. HbA_1c was measured using high-performance liquid chromatography. Serum GA and 1,5-AG levels were determined by enzymatic methods. Serum insulin levels were measured using an electrochemiluminescence immunoassay.

RESULTS

The study population included 208 FDR and 259 non-FDR. Serum 1,5-AG levels were lower in FDR than that in non-FDR (20.4 ± 7.5 vs 23.8 ± 8.3 μg/ml, P < 0.001), but HbA_1c and GA levels did not differ between them (P = 0.835 and 0.469, respectively). Logistic regression analysis revealed an independent relationship between a first-degree family history of diabetes and reduced serum 1,5-AG levels (odds ratio = 0.944, P < 0.001). Multiple regression analysis showed that a first-degree family history of diabetes (β = -3.041, P < 0.001) and insulinogenic index (β = 0.081, P = 0.001) were independently associated with serum 1,5-AG levels.

CONCLUSION

In a Chinese population with normal glucose tolerance, serum 1,5-AG levels were lower among FDR, and serum 1,5-AG levels were independently associated with FDR status. For FDR, serum 1,5-AG levels were more sensitive than HbA_1c or GA levels to early-phase abnormality in glucose metabolism.

Increased risk of metabolic disorders in healthy young adults with family history of diabetes: from the Korea National Health and Nutrition Survey

BACKGROUND

We assessed the impact of a family history of diabetes on type 2 diabetes, metabolic syndrome, and behavioral traits in young Korean adults.

METHODS

Subjects aged 25-44 years were included, and the presence of a family history of diabetes was obtained by a self-reported questionnaire (the Korea National Health and Nutrition Survey 2010). We compared the prevalence of type 2 diabetes and metabolic syndrome, and other metabolic parameters, including blood pressure and lipid profile.

RESULTS

Of 2059 participants, those with a family history of diabetes involving first-degree relatives (n = 489, 23.7%) had a significantly higher prevalence of impaired fasting glucose (14.3 vs. 11.7%) and type 2 diabetes (6.7 vs. 1.8%), compared to those without a family history (P < 0.001). The prevalence of metabolic syndrome (21.3 vs. 12.1%, P < 0.001) and its components (except for high-density lipoprotein cholesterol) were greater in subjects with a family history of diabetes. Among subjects exhibiting normal glucose tolerance (n = 1704), those with a family history of diabetes had higher fasting glucose (89.0 vs. 87.8 mg/dL, P < 0.001) and triglyceride (100.5 vs. 89.0 mg/dL, P < 0.001), and lower beta cell function by the homeostasis model assessment (HOMA-β; 134.2 vs. 137.5, P = 0.020). The obesity indices (body mass index, waist circumference, and triglyceride) were significantly correlated with those of both parents (P < 0.01 for all variables). Risk-reducing behavior, including regular exercise (18.2 vs. 19.7%, P = 0.469) and calorie intake (2174.8 vs. 2149.1 kcal/day, P = 0.636), did not markedly differ according to a family history of diabetes.

CONCLUSIONS

Young adults with a family history of diabetes had an increased risk of type 2 diabetes and metabolic syndrome, even though they currently exhibited a normal glycemic profile. Proactive lifestyle consultation is requested especially among healthy young population with a family history of diabetes.

Elevation in fibroblast growth factor 23 and its value for identifying subclinical atherosclerosis in first-degree relatives of patients with diabetes

Accumulating evidence supported an association between diabetes and fibroblast growth factor 23 (FGF23). The goal of the present study was to explore alteration in serum FGF23 levels and to assess its value for identifying subclinical atherosclerosis in normoglycemic individuals with a first-degree family history of diabetes (FHD). The study enrolled 312 subjects with a first-degree FHD and 1407 subjects without an FHD. Serum FGF23 levels were detected by a sandwich enzyme-linked immunosorbent assay. Serum FGF23 levels were much higher in subjects with a first-degree FHD than in those without an FHD (P = 0.006). A first-degree FHD was positively associated with serum FGF23 levels, independent of C-IMT and cardiovascular factors (both P < 0.05). In subjects with a first-degree FHD, only those with serum FGF23 levels in the upper quartile were more likely to have an increased C-IMT (odds ratio = 2.263, P < 0.05). As conclusions, a first-degree FHD contributes to the increased serum FGF23 levels independently. Subjects with a first-degree FHD need higher serum FGF23 levels to indicate subclinical atherosclerosis. The influence of a first-degree FHD on serum FGF23 levels should be considered to avoid overestimating the risk of cardiovascular disease in normoglycemic individuals with a first-degree FHD.

The influence of family history of diabetes on disease prevalence and associated metabolic risk factors among Sri Lankan adults

AIMS

To describe the influence of family history on diabetes prevalence and associated metabolic risk factors in a nationally representative sample from Sri Lanka.

METHODS

A cross sectional national survey was conducted among 5000 adults in Sri Lanka. Family history was evaluated at three levels: (1) parents, (2) grandparents (paternal and maternal) and (3) siblings. A binary-logistic regression analysis controlling for confounders (age, gender, BMI and physical activity) was performed in all patients with 'presence of diabetes' as the dichotomous dependent variable and using family history in father, mother, maternal grandmother/grandfather, paternal grandmother/grandfather, siblings and children as binary independent variables.

RESULTS

The sample size was 4485, mean age was 46.1 ± 15.1 years and 39.5% were males. In all adults, the prevalence of diabetes was significantly higher in patients with a family history (23.0%) than those without (8.2%) (P < 0.001). When family history was present in both parents, the prevalence of diabetes was 32.9%. Presence of a family history significantly increased the risk of diabetes [odds ratio (OR): 3.35, 95% confidence interval (CI): 2.78-4.03], obesity (OR: 2.45, 95% CI: 1.99-2.99), hypertension (OR: 1.25, 95% CI: 1.08-1.45) and metabolic syndrome (OR: 2.28, 95% CI: 1.97-2.63). In all adults, the presence of a family history of diabetes in a father (OR: 1.29, 95% CI: 1.02-1.63), mother (OR: 1.23, 95% CI: 1.11-1.36), paternal grandfather (OR: 1.27, 95% CI: 1.14-1.41), siblings (OR: 4.18, 95% CI: 3.34-5.22) and children (OR: 5.47, 95% CI: 2.93-10.19) was associated with a significantly increased risk of developing diabetes.

CONCLUSIONS

Family history and diabetes had a graded association in the Sri Lankan population, because the prevalence increased with the increasing number of generations affected. Family history of diabetes was also associated with the prevalence of obesity, metabolic syndrome and hypertension. Individuals with a family history of diabetes form an easily identifiable group who may benefit from targeted interventions.

Risk factors for coronary heart disease in patients below 45 years of age

Objective: To examine the traditional risk factors and biochemical profile of patients with established CAD (coronary artery disease), and compare the trends of these in specified age groups of different populations as depicted in various studies.

Methodology: All consecutive patients below 45 years of age, having classical history of Ischemic heart disease and also having definite ECG changes consistent with coronary artery disease were enrolled. These patients were admitted to CCU/Intermediate Coronary Care Unit of Pakistan Ordinance Factories (POF) Hospital Wah Cantonment from April 2007 to December 2011. Patients who had doubtful history as regards CHD and those having ECG changes not classically consistent with CAD were excluded. Information collected through Performa included history including family history and details of risk factors. Clinical examination was carried out and relevant investigations including the serial ECG changes were recorded. Blood samples were collected after an overnight fast of 14 hours and tests were done for total cholesterol and HDL cholesterol by using Pioneer-USA, linear chemical kits by cholesterol oxidase and enzymatic calometric method.

Results: A total of 109 cases were included. Cigarette smoking (46%) Family history (43%), Hypertension (37%), Dyslipidemia (33%), Diabetes mellitus (18%) and above normal BMI (63.3%) are the most common risk factors in our patients. Increased abdominal girth has appeared to be an important risk factor and at occasions is documented to be independent of obesity. Casual dietary habits and sedentary life style are the other less important risk factors. The majority of risk factors were equally prevalent in males as well as females except smoking which was less prevalent in females.

Conclusions: Our study shows that Family history, Smoking, Hypertension, increased BMI, increased Abdominal girth, Dyslipidemia and Diabetes Mellitus are the main risk factors. Considering the increasing incidence of the coronary heart disease in our society it is essential to assess and evaluate these risk factors at national level.

Health beliefs among individuals at increased familial risk for type 2 diabetes: implications for prevention

AIM

To evaluate perceived risk, control, worry, and severity about diabetes, coronary heart disease (CHD) and stroke among individuals at increased familial risk of diabetes.

METHODS

Data analyses were based on the Family Healthware™ Impact Trial. Baseline health beliefs were compared across three groups: (1) no family history of diabetes, CHD or stroke (n=836), (2) family history of diabetes alone (n=267), and (3) family history of diabetes and CHD and/or stroke (n=978).

RESULTS

After adjusting for age, gender, race, education and BMI, scores for perceived risk for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001) were lowest in Group 1 and highest in Group 3. Similar results were observed about worry for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001). Perceptions of control or severity for diabetes, CHD or stroke did not vary across the three groups.

CONCLUSIONS

Among individuals at increased familial risk for diabetes, having family members affected with CHD and/or stroke significantly influenced perceived risk and worry. Tailored lifestyle interventions for this group that assess health beliefs and emphasize approaches for preventing diabetes, as well as its vascular complications, may be an effective strategy for reducing the global burden of these serious but related chronic disorders.

A family history of diabetes mellitus is associated with poor glycemic control and increased metabolic risks among people with diabetes: data from the National Health and Nutrition Examination Survey 1999-2004

BACKGROUND

Several lines of evidence from studies involving both general and non-diabetic populations have shown that a family history of diabetes was associated with an increased risk for cardiovascular diseases and metabolic alterations. However, little is known about the relationship of a family history of diabetes to glycemic control and metabolic risks among people with diabetes.

METHODS

We conducted a cross-section study of 946 diabetic adults from the National Health and Nutrition Examination Survey between 1999 and 2004. Familial risk of diabetes was classified as average, moderate, or high. Logistic regression analyses were conducted to determine the association between familial risk of diabetes and poor glycemic control, as defined by A1C > or = 8%. According to stratified levels of familial risk of diabetes, adjusted means of various metabolic risks, including A1C, BMI, lipid profiles, and C-reactive protein, were obtained by using multiple linear regression.

RESULTS

Independent of basic demographics, health-related behaviors, use of anti-diabetic medications, diabetes duration, cardiovascular co-morbidities, and various metabolic risks, the odds ratio of poor glycemic control comparing participants with a high familial risk of diabetes to those with an average risk was 1.91 (95% confidence interval 1.02-3.58). In the multivariate analysis, the adjusted means of A1C in participants with high, moderate, and averaged familial risk of diabetes were 7.75%, 7.45%, and 7.25%, respectively (p for trend 0.036). Participants with a high familial risk of diabetes also had higher triglycerides and body mass index (p for trend 0.042 and 0.02, respectively).

CONCLUSION

Diabetic adults with a higher familial risk of diabetes have a worse glycemic control, higher BMI, and higher triglycerides. Obtaining family history of the disease is crucial in identifying and targeting high risk diabetic patients who may require more stringent lifestyle changes as well as pharmaceutical intervention.

Relation of familial patterns of coronary heart disease, stroke, and diabetes to subclinical atherosclerosis: the multi-ethnic study of atherosclerosis

PURPOSE

To investigate the possibility that family history beyond early-onset coronary heart disease might contribute to coronary heart disease susceptibility, we studied associations between additional family history and the coronary artery calcium score.

METHODS

Associations between coronary artery calcium score and self-reports of coronary heart disease, stroke, and diabetes in first-degree relatives of 5264 nondiabetic subjects were assessed using logistic and linear regression adjusting for risk factors; adjusted mean coronary artery calcium score estimates were determined by pooling results.

RESULTS

Family history of coronary heart disease alone and in combination with diabetes and/or stroke was significantly associated with a positive coronary artery calcium score compared with no family history with odds ratios ranging from 1.7 (95% CI: 1.3-2.3) to 1.9 (95% CI: 1.6-2.3) and adjusted mean coronary artery calcium score estimates ranging from 137 (95% CI: 101-173) to 184 (95% CI: 143-226). Associations between family history of coronary heart disease and coronary artery calcium score were significant regardless of age at onset, sex, lineage, or number of relatives with coronary heart disease. The association between family history of diabetes only and coronary artery calcium score was also significant (OR, 1.3; 95% CI: 1.1-1.7) with an adjusted mean coronary artery calcium score estimate of 122 (95% CI: 93-151). Generally, family history of stroke had nonsignificant associations with coronary artery calcium score.

CONCLUSIONS

Numerous family history variables in addition to early-onset coronary heart disease are associated with subclinical atherosclerosis. Our results have implications for improving coronary heart disease risk assessment.