Prevalence of non-traditional cardiovascular disease risk factors among persons with impaired fasting glucose, impaired glucose tolerance, diabetes, and the metabolic syndrome: analysis of the Third National Health and Nutrition Examination Survey (NHANES III).

Abstract

To calculate the prevalence of non-traditional cardiovascular disease (CVD) risk factors across diabetes status and for persons with and without the metabolic syndrome. Data were analyzed from the Third National Health and Nutrition Examination Survey for normal plasma glucose [<100 mg/dl, n=4589]; impaired fasting glucose [IFG, 100-125 mg/dl, n=2008], diabetes [fasting glucose #10878; 126 mg/dl or diabetes medication, n=750]; and participants with and without the metabolic syndrome, n=1938 and n=5409, respectively. After adjustment for age, race, sex, body mass index, physical inactivity, cigarette smoking and alcohol consumption, a higher odds (p-trend < 0.01) of the metabolic syndrome, an elevated HOMA-insulin resistance index, chronic kidney disease, elevated C-reactive protein, high fibrinogen, and high white blood cell count was observed across diabetes status. After similar adjustment, the metabolic syndrome was associated with (odds ratio; 95% confidence interval) low apolipoprotein A1 (2.27: 1.30,3.96), high apolipoprotein-B (2.97: 2.03,4.34), a higher HOMA insulin resistance index (5.25: 4.16, 6.63), chronic kidney disease (2.27: 1.42, 3.63), and elevated markers of inflammation [high white blood cell count (1.55: 1.14, 2.10), and elevated C-reactive protein (1.46: 1.06, 2.00)]. Among participants with IFG, the presence of impaired glucose tolerance (IGT) was associated with a higher prevalence of the HOMA insulin reistance index, 32.3%, high fibrinogen, 18.5%, and elevated C-reactive protein, 13.2%, compared to persons with IFG alone, 19.7%, 13.3% and 5.7%, respectively (each p <== 0.05). In this representative of the US population, an increased prevalence of non-traditional CVD risk factors was present among persons with diabetes, IGT and IFG compared to IFG alone, and the metabolic syndrome.