Cardiovascular disease in older adults with glucose disorders: comparison of American Diabetes Association criteria for diabetes mellitus with WHO criteria

Background The new fasting American Diabetes Association (ADA) criteria for the diagnosis of diabetes mellitus rely mainly on fasting blood glucose co ncentrations and use a lower cutoff value for diagnosis than the WHO criter ia. We aimed to assess the sensitivity of these criteria for the detection of cardiovascular disease, the main complication of diabetes mellitus in th e elderly. Methods We did a cross-sectional and prospective analysis of 4515 participa nts of the Cardiovascular Health Study, an 8-year longitudinal study design ed to identify factors related to the onset and course of cardiovascular di sease in adults aged at least 65 years. We calculated the prevalence and in cidence of cardiovascular disease for the ADA and WHO criteria. Findings There was a higher prevalence of cardiovascular disease among indi viduals with impaired glucose or newly diagnosed diabetes by both criteria than among those with normal glucose concentrations. However, because fewer individuals had abnormal glucose states by the fasting ADA criteria (22.3% ) than by the WHO criteria (46.8%), the number of cases of cardiovascular d isease attributable to abnormal glucose stales was a third of that attribut able by the WHO criteria (53 vs 159 cases per 10 000), For the two sets of criteria, the relative risk for incident cardiovascular disease (mean follo w-up 5.9 years) was higher in individuals with impaired glucose and newly d iagnosed diabetes than in those with normal glucose. Individuals classified as normal by the fasting ADA criteria had a higher absolute number of inci dent events (455 of 581 events) than those classified as normal by the WHO criteria (269 of 581 events). Fasting ADA criteria were therefore less sens itive than the WHO criteria for predicting cardiovascular disease among ind ividuals with abnormal glucose (sensitivity, 28% vs 54%), Interpretation The new fasting ADA criteria seem to be less predictive than the WHO criteria for the burden of cardiovascular disease associated with abnormal glucose in the elderly.