Prevalence of clinical and isolated subclinical cardiovascular disease in older adults with glucose disorders - The Cardiovascular Health Study

OBJECTIVE - Clinical cardiovascular disease (CVD) is highly prevalent among people with diabetes. However, there is little information regarding the p revalence of subclinical CVD and its relation to clinical CVD in diabetes a nd in the glucose disorders that precede diabetes. RESEARCH DESIGN AND METHODS - Participants in the Cardiovascular Health Stu dy, aged greater than or equal to 65 years (n = 5,888), underwent vascular and metabolic testing. Individuals with known disease in the coronary, cere bral, or peripheral circulations were considered to have clinical disease. Those without any clinical disease in whom CVD was detected by ultrasonogra phy, electrocardiography, or ankle arm index in any of the three vascular b eds were considered to have isolated subclinical disease. RESULTS - Approximately 30% of the cohort had clinical disease, and similar to 60% of the remainder had isolated subclinical disease. In those with no rmal glucose status, isolated subclinical disease made up most of the total CVD. With increasing glucose severity, the proportion of total CVD that wa s clinical disease increased; 75% of men and 66% of women with normal fasti ng glucose status had either clinical or subclinical CVD. Among those with known diabetes, the prevalence was similar to 88% (odds ratio [OR] 2.46 for men and 4.22 for women, P < 0.0001). There were intermediate prevalences a nd ORs for those with impaired fasting glucose status and newly diagnosed d iabetes. CONCLUSIONS - Isolated subclinical CVD is common among older adults. Glucos e disorders are associated with an increased prevalence of total CVD and an increased proportion of clinical disease relative to subclinical disease.