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Glycaemia and albuminuria as predictors of coronary heart disease in Aboriginal and Torres Strait Islander adults: a north Queensland cohort

Robyn A McDermott, Brad McCulloch and Ming Li
Med J Aust 2011; 194 (10): 514-518.

Summary

Objective: To evaluate the contribution of non-traditional risk factors to coronary heart disease (CHD) incidence in Indigenous adults.

Design, setting and participants: Cohort study of 1706 Aboriginal and Torres Strait Islander adults from 26 remote communities in far north Queensland who were initially free of CHD, with a mean of 7.5 years of follow-up.

Main outcome measures: CHD-related deaths and hospitalisations obtained by record matching.

Results: CHD incidence was similar in men and women and in Aboriginals and Torres Strait Islanders; overall incidence was 12.1 (95% CI, 10.1–14.1) events per 1000 person-years. At baseline, prevalence of diabetes was 12.4% in Aboriginals and 22.3% in Torres Strait Islanders, prevalence of any albuminuria was similarly high (33.5%) in both groups, and participants with diabetes were 5.5 (95% CI, 4.2–7.3) times more likely to have albuminuria than those without diabetes. At follow-up, adjusted hazard ratios for CHD were 1.7 (95% CI, 1.01–2.8) for obesity based on waist circumference; 1.5 (95% CI, 1.01–2.3) for hypertension; 1.4 (95% CI, 0.9–2.2) for previous or current smoking; 1.9  (95% CI, 1.3–2.7) for elevated triglycerides; 1.3 (95% CI, 0.9–1.9) for low high-density lipoprotein cholesterol; 1.3 (95% CI, 0.8–2.2) for impaired fasting glucose; 2.4 (95% CI, 1.7–3.5) for diabetes; and 4.6 (95% CI, 2.9–7.1) for macroalbuminuria. Baseline albuminuria without diabetes increased risk by 50% (adjusted rate ratio, 1.5 [95% CI, 0.9–2.4]) but diabetes with macroalbuminuria amplified risk sixfold (adjusted rate ratio, 5.9 [95% CI, 3.4–10.1]).

Conclusion: High prevalence of glycaemia and albuminuria in this population, especially when combined, account for much of the excess CHD risk beyond the traditional Framingham risk factors. They can be measured simply, lend themselves to cardioprotective interventions, and should be used routinely to estimate risk and monitor effectiveness of treatment.

  • Robyn A McDermott1
  • Brad McCulloch2
  • Ming Li1

  • 1 Sansom Institute for Health Research, University of South Australia, Adelaide, SA.
  • 2 Tropical Public Health Unit, Queensland Health, Cairns, QLD.


Acknowledgements: 

This study was supported partly by National Health and Medical Research Council Project Grant Number 279402. Our thanks also to Queensland Health staff for assistance with data collection and record linkage.

Competing interests:

None identified.

  • 1. Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. Canberra: AIHW, 2008. (AIHW Cat. No. IHW 21.)
  • 2. Wang Z, Hoy W. Association between diabetes and coronary heart disease in Aboriginal people: are women disadvantaged? Med J Aust 2004; 180: 508-511. <MJA full text>
  • 3. Bradshaw PJ, Alfonso HS, Finn JC, et al. Coronary heart disease events in Aboriginal Australians: incidence in an urban population. Med J Aust 2009; 190: 583-586. <MJA full text>
  • 4. Queensland Health, Royal Flying Doctor Service, editors. Chronic disease guidelines. 2nd ed. Cairns: Queensland Health, 2007.
  • 5. Miller G, McDermott R, McCulloch B, et al. The Well Person’s Health Check: a population screening program in indigenous communities in north Queensland. Aust Health Rev 2002; 25: 136-147.
  • 6. McDermott RA, Li M, Campbell SK. Incidence of type 2 diabetes in two Indigenous Australian populations: a 6-year follow-up study. Med J Aust 2010; 192: 562-565. <MJA full text>
  • 7. Juutilainen A, Kortelainen S, Lehto S, et al. Gender difference in the impact of type 2 diabetes on coronary heart disease risk. Diabetes Care 2004; 27: 2898-2904.
  • 8. Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ 2006; 332: 73-77.
  • 9. Lee ET, Howard BV, Wang W, et al. Prediction of coronary heart disease in a population with high prevalence of diabetes and albuminuria: the Strong Heart Study. Circulation 2006; 113: 2897-2905.
  • 10. Levitan EB, Song Y, Ford ES, Liu S. Is nondiabetic hyperglycemia a risk factor for cardiovascular disease? A meta-analysis of prospective studies. Arch Intern Med 2004; 164: 2147-2155.
  • 11. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2004; 27 Suppl 1: S5-S10.
  • 12. Lawes CM, Parag V, Bennett DA, et al; Asia Pacific Cohort Studies Collaborative. Blood glucose and risk of cardiovascular disease in the Asia Pacific region. Diabetes Care 2004; 27: 2836-2842.
  • 13. Milicevic Z, Raz I, Beattie SD, et al. Natural history of cardiovascular disease in patients with diabetes: role of hyperglycemia. Diabetes Care 2008; 31 (Suppl): S155-S160.
  • 14. Nag S, Bilous R, Kelly W, et al. All-cause and cardiovascular mortality in diabetic subjects increases significantly with reduced estimated glomerular filtration rate (eGFR): 10 years’ data from the South Tees Diabetes Mortality study. Diabetic Medicine 2007; 24: 10-17.
  • 15. de Zeeuw D, Remuzzi G, Parving H-H, et al. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 2004; 110: 921-927.
  • 16. Ibsen H, Olsen MH, Wachtell K, et al. Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: losartan intervention for endpoint reduction in hypertension study. Hypertension 2005; 45: 198-202.

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