Abstract
To evaluate the joint effect of hypertension (HTN) and diabetes (DM) on coronary heart disease (CHD), and stroke event, all-cause, and cardiovascular disease (CVD) mortality in Middle Eastern older adults, 2747 people (1436 women) aged ≥ 50 years, free of CVD at baseline, were categorized into four groups (HTN−/DM−, HTN+/DM−, HTN−/DM+, HTN+/DM+). Multivariate Cox proportional hazard models were run for different outcomes. To compare the impact of HTN versus DM, HTN+/DM− was considered as reference. In a median of 13.9 years, incidence rate of CHD, and stroke event, all-cause and CVD mortality in total population were 19.0, 4.7, 13.5, and 6.4 per 1000 person-years, respectively. The multivariate sex-adjusted hazard ratios (HRs) of HTN−/DM+ for CHD, stroke, all-cause mortality and CVD mortality were 1.19 (confidence interval (CI): 0.9–1.57), 1.07 (CI: 0.63–1.82), 1.62 (CI: 1.2–2.18), and 1.28 (CI: 0.83–1.97); the corresponding HRs for HTN+/DM+ were 1.96 (CI: 1.57–2.46), 1.66 (CI: 1.1–2.52), 2.32 (CI: 1.8–2.98), and 2.6 (CI: 1.85–3.65) respectively. The associations between HTN/DM status with stroke incidence and all-cause mortality were stronger among men than in women (P for interaction <0.05). Compared to HTN+/DM−, HTN−/DM+ increases all-cause mortality by 62%, however, they are not considerably different regarding CHD, stroke incidence and CVD mortality.
Highlights
The world’s population is aging, (1) a trend that is projected to accelerate in the following decades
Multivariate Cox proportional hazard model adjusted for sex, age, body mass index, waist to hip ratio, education level, low physical activity, current smoking, and hypercholesterolemia was used to evaluate the associations of different combinations of hypertension and diabetes with incident coronary heart disease (CHD), and stroke events, all-cause and cardiovascular disease (CVD) mortality; given HTN−/diabetes mellitus (DM)− as the reference
Conducted among the Iranian adults aged 50 years or above during a more than a decade follow-up, the current study showed that compared to those who were HTN−/DM− at baseline, both hypertension and diabetes either alone or accompanied together increased the risk of CHD event, all-cause and CVD mortality both in men and women
Summary
The world’s population is aging, (1) a trend that is projected to accelerate in the following decades. Aging population is at increased risk of developing hypertension (HTN) and type 2 diabetes mellitus (DM)[2,3,4], which are two well-known risk factors of cardiovascular disease (CVD)[5], the leading cause of death worldwide[6]. To the best of our knowledge, there is no evidence regarding the comparative effect of these risk factors on CVD morbidity and mortality in the older adults among the Middle East population which has the highest burden of CVD risk factors and its mortality[15]. The aim of the current study is to first evaluate the total and sex-specified joint effect of hypertension and diabetes on coronary heart disease (CHD), and stroke event, all-cause, and CVD mortality in older adults in a long-term population based cohort study. To compare the impact of hypertension versus diabetes on the abovementioned outcomes in this population
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