Cardiovascular disease in insulin dependent diabetes mellitus: similar rates but different risk factors in the US compared with Europe

Background Cardiovascular disease (CVD) in insulin dependent diabetes melli tus (IDDM) has been linked to renal disease. However, little is known conce rning international variation in the correlations with hyperglycaemia and s tandard CVD risk factors. Methods A cross-sectional comparison was made of prevalence rates and risk factor associations in two large studies of IDDM subjects: the Pittsburgh E pidemiology of Diabetes Complications Study (EDC) and the EURODIAB IDDM Com plications Study from 31 centres in Europe. Subgroups of each were chosen t o be comparable by age and duration of diabetes. The EDC population compris es 286 men (mean duration 20.1 years) and 281 women (mean duration 19.9 yea rs); EURODIAB 608 men (mean duration 18.1 years) and 607 women (mean durati on 18.9 years). The mean age of both populations was 28 years. Cardiovascul ar disease was defined by a past medical history of myocardial infarction, angina, and/or the Minnesota ECG codes (1.1-1.3, 4.1-4.3, 5.1-5.3, 7.1). Results Overall prevalence of CVD was similar in the two populations (i.e, men 8.6% versus 8.0%, women 7.4% versus 8.5%, EURODIAB versus EDC respectiv ely), although EDC women had a higher prevalence of angina (3.9% versus 0.5 %, P < 0.001). Multivariate modelling suggests that glycaemic control (HbA( 1c)) is not related to CVD in men. Age and high density lipoprotein cholest erol predict CVD in EURODIAB, while triglycerides and hypertension predict CVD in EDC. For women in both populations, age and hypertension (or renal d isease) are independent predictors. HbA(1c) is also an independent predicto r-inversely in EURODIAB women (P < 0.008) and positively in EDC women (P = 0.03). Renal disease was more strongly linked to CVD in EDC than in EURODIA B. Conclusions Despite a similar prevalence of CVD, risk factor associations a ppear to differ in the two study populations. Glycaemic control (HbA(1c)) d oes not show a consistent or strong relationship to CVD.