Diabetes Mellitus is the Main Risk Factor for Early Cardiovascular Mortality among General Population in Spain: Drece follow up Project

Abstract

Mediterranean diet countries held the paradox of very low cardiovascular mortality and high levels of cardiovascular risk factors. The aim is to describe evolution and relationship of main cardiovascular risk factors, diet, and mortality during 1991–2004 in Spain. The Diet and Cardiovascular Risk in Spain project is a general population based follow up cohort study started in 1991. It is composed of 4783 individuals from 15 to 60 ages in the inception, and it is a representative sample of the Spanish nationwide general population. Vital status and cause of death was provided by the National Institute of Statistics. Mortality rates and risk factors were estimated by Poisson and Cox regression, hazard ratio (HR), procedures respectively. There were 125 deaths (70930 person-years). Causes of death were: 53 (42,4%) cancer, 31 (24,8%) circulatory system, and 24 (19%) cardiovascular. Mean age for all causes death was 56.6 years, for cancer 58.32 years, and for cardiovascular 59.04 years. Risk factors for all causes mortality were: Creatinine >1.5 mgr/dl, HR 3.78 (95%CI:1.52–9.40); Diabetes Mellitus HR 2.80 (95%CI:1.74–4.46); Male Sex HR 2.39 (95%CI:1.61–3.55); Age HR 1.08 (95%CI:1.07–1.10); and Gammaglutamyl transpeptidase HR 1.001 (1.000–1.003). For cancer deaths: Age HR 1.12 (95%CI: 1.09–1.16); and Tobacco HR 1.33 (95%CI: 1.14–1.54). For cardiovascular diseases: Creatinine >1.5 mg/dl, HR 19.40 (95%CI: 5.45–69.12); Diabetes Mellitus HR 9.82 (95%CI:4.19–23.04); and Age HR 1.10 (95%CI:1.05–1.15). We found a mortality profile where cancer is the most frequent cause of death following recent trends in western countries but we emphasize the role of Diabetes Mellitus and Creatinine (probably as diabetes kidney damage surrogate variable) as early and strong risk factors for cardiovascular mortality and therefore for all causes death. No diet pattern or other cardiovascular risk factors were significantly associated. Diabetes emerges as a priority target for action in Mediterranean diet countries.