Nontraditional risk factors for coronary heart disease incidence among persons with diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Major risk factors explain much of the excess risk for coronary heart disease produced by diabetes, but nontraditional factors may also re late to incident coronary heart disease. Objective: To examine the association of traditional and nontraditional ris k factors with incidence of coronary heart disease in adults with diabetes. Design: Prospective cohort study, Setting: The Atherosclerosis Risk in Communities (ARIC) Study. Participants: 1676 middle-aged persons who had diabetes but no history of p revalent coronary heart disease. Measurements: Multiple risk factors were recorded at baseline. Follow-up wa s from 1987 through 1995, Results: 186 participants developed incident coronary heart disease events during follow-up. As expected, the incidence of coronary heart disease in p articipants with diabetes was associated positively with traditional risk f actors (hypertension, smoking, total cholesterol level, and low high-densit y lipoprotein [HDL] cholesterol level). After adjustment for sex, age, ethn icity, and ARIC field center, incident coronary heart disease was also sign ificantly associated with waist-to-hip ratio; levels of HDL3 cholesterol, a po-lipoproteins A-1 and B, albumin, fibrinogen, and von Willebrand factor; factor VIII activity; and leukocyte count. However, after adjustment for tr aditional risk factors for coronary heart disease, only levels of albumin, fibrinogen, and von Willebrand factor; factor VIII activity; and leukocyte count remained independently associated with coronary heart disease (P < 0. 03). The relative risks associated with the highest compared with lowest gr oupings of albumin, fibrinogen, factor VIII, and von Willebrand factor valu es and leukocyte count were 0.64 (95% CI, 0.44 to 0.92), 1.75 (CI, 1.12 to 2.73), 1.58 (CI, 1.02 to 2.42), 1.71 (Cl, 1.11 to 2.63), and 1.90 (Cl, 1.16 to 3.13), respectively. Adjustment for diabetes treatment status attenuate d these associations somewhat Conclusions: Levels of albumin, fibrinogen, and von Willebrand factor; fact or VIII activity; and leukocyte count were predictors of coronary heart dis ease among persons with diabetes. These associations may reflect 1) the und erlying inflammatory reaction or microvascular injury related to atheroscle rosis and a tendency toward thrombosis or 2) common antecedents for both di abetes and coronary heart disease.