Factor VIII and other hemostasis variables are related to incident diabetes in adults - The Atherosclerosis Risk in Communities (ARIC) study

OBJECTIVE - Our objective was to evaluate whether selected hemostasis varia bles, some of which may reflect inflammation or endothelial dysfunction, ar e independently associated with the development of diabetes. RESEARCH DESIGN AND METHODS - We studied a biethnic cohort of 12,330 men an d women, 45-64 years of age, of the Atherosclerosis Risk in Communities Stu dy. New cases of diabetes were diagnosed by a reported physician diagnosis, hypoglycemic medication use, or a casual or fasting serum glucose level of greater than or equal to 11.1 or greater than or equal to 7 mmol/l, respec tively. RESULTS - Over an average follow-up of 7 years, 1,335 new cases of diabetes were detected. The odds ratios (4th versus Ist quartile) of developing dia betes, adjusted by logistic regression for age, sex, race, study center, fa mily history of diabetes, fasting glucose, physical activity and smoking, w ere 1.2 (95% CI 1.0-1.5) for fibrinogen and 1.4 (1.1-1.6) for factor VII. A ssociations for factor VIII, von Willebrand factor, and activated partial t hromboplastin time were found to be 1.8 (1.3-2.3), 1.4 (1.1-1.8), and 0.63 (0.49-0.82), respectively in women. Although further adjustment for BMI and waist-to-hip ratio diminished the relationships, a highly statistically si gnificant association (P = 0.001) remained for factor VIII (1.6 [1.2-2.1]) in women. CONCLUSIONS - Factor VIII and other hemostasis variables are associated wit h the development of diabetes in middle-aged adults. These findings support a role for inflammation and, particularly in women, endothelial dysfunctio n in the pathogenesis of type 2 diabetes.