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Biomedical subjects

N Chaturvedi

Publications and source records attributed to N Chaturvedi.

At least 19 recordsLinked to original sources
PubMed1999

[Effect of lisinopril on progression of retinopathy and microalbuminuria in normotensive subjects with insulin-dependent diabetes mellitus].

Effect of lisinopril on progression of retinopathy and microalbuminuria in normotensive subjects with insulin-dependent diabetes mellitus. Retinopathy and nephropathy are the most important microvascular complications in diabetes with hyperglycaemia and hypertension as important risk factors. Antihypertensive treatment with angiotensin-converting enzyme inhibitors has been shown to delay progression of nephropathy, but the effect on retinopathy has not been established. We, therefore, performed a trial of the effect of the ACE-inhibitor lisinopril on retinopathy and nephropathy in normotensive patients with IDDM. We performed a two year randomized double-blind placebo-controlled trial of the ACE-inhibitor lisinopril on 530 normotensive IDDM patients within the age group 20-59 years from 18 European centres. Patients were either normo- or microalbuminuric. Retinopathy was classified from retinal photographs into five levels (none to proliferative). The primary endpoint of the trial was progression of albuminuria. Mean albumin excretion rate (AER) was 8.0 micrograms/min at baseline in both treatment groups. After two years AER was 2.2. micrograms/min lower in the lisinopril than in the placebo group, a difference of 18.8% (p = 0.03). The difference in AER was 38.5 micrograms/min between treatment groups in patients with microalbuminuria at baseline (p = 0.001), and 0.23 microgram/min in patients with normoalbuminuria at baseline (p = 0.6). Retinopathy was a secondary endpoint. Patients treated with lisinopril had significantly lower Hb-A1c at baseline than the placebo group (6.9%-7.3%). Retinopathy progressed with at least one level in 13.2% of lisinopril treated and 23.4% of placebo treated patients (odds ratio 0.50, p = 0.02). Progression by two levels or progression to proliferative retinopathy were also significantly reduced in the lisinopril group compared to the placebo group (odds ratio 0.27 and 0.18, respectively). In conclusion, lisinopril delays progression of retinopathy and nephropathy in normotensive IDDM patients with micro- or normoalbuminuria.

Adult↗
PubMed1999

Factors associated with obesity in South Asian, Afro-Caribbean and European women.

OBJECTIVE: To investigate correlates of body mass index (BMI) and other anthropometric measurements in South Asian, Afro-Caribbean and European women in the UK. SUBJECTS: 291 South Asian, 303 Afro-Caribbean, and 559 European women aged 40-69y in West London, UK. DESIGN: Cross-sectional survey. MAIN OUTCOME MEASURES: BMI, waist-to-height ratio (WHt), and skinfold thicknesses. RESULTS: Compared with European women, South Asian and Afro-Caribbean women were more like to be obese (odds ratios (OR) 1.83 and 3.01, respectively), but less likely to rate themselves as overweight (BMI-adjusted OR 0.19 and 0.34, respectively). The proportion of women who walked at least 2.5 km/d, excluding activity at work, was lower in South Asians (22%) than in Europeans (44%) or Afro-Caribbeans (40%). Among employed women, the proportion who were active at work was higher in South Asians (63%) and Afro-Caribbeans (70%) than in Europeans (49%). In Europeans, obesity was inversely associated with social class, education, smoking, alcohol intake, and distance walked, and positively associated with time spent watching television. Adjustment for alcohol intake, smoking, education and transport, physical activity explained over 80% of the difference in BMI between South Asians and Europeans, but not the difference between Afro-Caribbeans and Europeans. CONCLUSION: The factor that may be most amenable to intervention in South Asian women is low physical activity outside the workplace. The high prevalence of obesity in Afro-Caribbean women, however, is not accounted for by any behavioural factors measured in this study, and the reasons for high rates of obesity in this group remain to be established.

Adult↗
PubMed1999

Developing risk stratification charts for diabetic and nondiabetic subjects.

AIMS: To provide estimates of the 10-year risk of coronary heart disease events for diabetic and nondiabetic men and women with different levels of risk factors and, for diabetic subjects, with and without microalbuminuria. METHODS: Use of risk coefficients derived from the Framingham Study and a meta-analysis of the influence of microalbuminuria on cardiovascular disease. The risk of a coronary heart disease event has been calculated for men and women with and without diabetes mellitus, and among diabetic subjects, with and without microalbuminuria, according to age, systolic blood pressure and the ratio of total to high density lipoprotein cholesterol. RESULTS: These risk estimates have been developed as a series of colour charts. The use of Framingham estimates of risk have been validated by comparing them with estimates derived from the Dundee Risk Disk and from the PROCAM Study, these estimates providing reasonable agreement despite the geographical and temporal differences in their development. CONCLUSIONS: These charts permit the overall level of risk to be derived, which can inform decision making about thresholds for therapeutic interventions, as well as assisting in patient education.

Adult↗
PubMed1999

Relationships of fasting and postload glucose levels to sex and alcohol consumption. Are American Diabetes Association criteria biased against detection of diabetes in women?

OBJECTIVE: To compare, in men and women, the prevalence of undiagnosed type 2 diabetes assessed using criteria from the American Diabetes Association (ADA) and the World Health Organization (WHO) and to investigate risk factors associated with fasting and 2-h postload plasma glucose. RESEARCH DESIGN AND METHODS: Data from two companion surveys of Europeans, South Asians, and Afro-Caribbeans in west London were used. A total of 4,367 men and women aged 40-64 years who were not known to have diabetes underwent an oral glucose tolerance test after an overnight fast. The prevalence of undiagnosed diabetes was estimated using the ADA (fasting plasma glucose > or = 7.0 mmol/l) and WHO (2-h postload glucose > or = 11.1 mmol/l) criteria for epidemiologic studies. The association of body fat and usual alcohol intake with plasma glucose and diabetes prevalence was assessed. RESULTS: Compared with the WHO criterion, the ADA criterion gave a higher prevalence of diabetes in men (6.4 vs. 4.7%) but a lower prevalence in women (3.3 vs. 4.2%). In Afro-Caribbeans, the sex difference in diabetes prevalence was reversed. Women had significantly lower fasting glucose than men despite higher 2-h glucose levels. Alcohol intake was positively associated with fasting glucose in men and women but not with 2-h glucose levels. CONCLUSIONS: The new ADA criterion, based on fasting glucose alone, does not take account of sex differences in metabolic response to fasting or possible artifactual effects on fasting glucose. With the ADA criterion, alcohol intake was a significant risk factor for diabetes in our study population; this was not the case with the WHO criterion.

Adult↗
PubMed1998

Socioeconomic gradient in morbidity and mortality in people with diabetes: cohort study findings from the Whitehall Study and the WHO Multinational Study of Vascular Disease in Diabetes.

OBJECTIVE: To assess whether the inverse socioeconomic mortality gradient observed in the general population persists in diabetic people. DESIGN: The Whitehall cohort study and the London cohort of the WHO multinational study of vascular disease in diabetes. SETTING: London. SUBJECTS: 17,264 male civil servants (17,046 without diabetes, 218 with diabetes) aged 40-64 examined in 1967-9, and 300 people with diabetes aged 35-55 from London clinics examined in 1975-7. Both cohorts were followed up until January 1995. MAIN OUTCOME MEASURES: Mortality from all causes, cardiovascular disease, and ischaemic heart disease. RESULTS: In both cohorts people in the lower social groups were older, had higher blood pressure, and were more likely to smoke. In the Whitehall study, the prevalence of heart disease was higher in the lowest social group compared with the highest group, by 6% among non-diabetic people (P = 0.0001) and by 14% among diabetic subjects (P = 0.02). In the WHO study proteinuria was more common in the lowest social group compared with the highest (27% v 15%, P = 0.01), as was retinopathy (54% v 48%, P = 0.5). There was a clear socioeconomic gradient in all cause mortality in both cohorts, with death rates being about twice as high in the lowest compared with the highest social groups. In the Whitehall study this gradient was similar in both diabetic and non-diabetic subjects, and it persisted for mortality from cardiovascular disease and from ischaemic heart disease. About half of the increased risk of death in the lowest social group was accounted for by blood pressure and smoking. CONCLUSIONS: We confirm the existence of an inverse socioeconomic mortality gradient in diabetic people and suggest that this is largely due to conventional cardiovascular risk factors.

Adult↗
PubMed1998

Effect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes. The EUCLID Study Group. EURODIAB Controlled Trial of Lisinopril in Insulin-Dependent Diabetes Mellitus.

BACKGROUND: Retinopathy commonly occurs in people with type 1 diabetes. Strict glycaemic control can decrease development and progression of retinopathy only partially. Blood pressure is also a risk factor for microvascular complications. Antihypertensive therapy, especially with inhibitors of angiotensin-converting enzyme (ACE), can slow progression of nephropathy, but the effects on retinopathy have not been established. We investigated the effect of lisinopril on retinopathy in type 1 diabetes. METHODS: As part of a 2-year randomised double-blind placebo-controlled trial, we took retinal photographs at baseline and follow-up (24 months) in patients aged 20-59 in 15 European centres. Patients were not hypertensive, and were normoalbuminuric (85%) or microalbuminuric. Retinopathy was classified from photographs on a five-level scale (none to proliferative). FINDINGS: The proportion of patients with retinopathy at baseline was 65% (117) in the placebo group and 59% (103) in the lisinopril group (p = 0.2). Patients on lisinopril had significantly lower HbA1c at baseline than those on placebo (6.9% vs 7.3 p = 0.05). Retinopathy progressed by at least one level in 21 (13.2%) of 159 patients on lisinopril and 39 (23.4%) of 166 patients on placebo (odds ratio 0.50 [95% CI 0.28-0.89], p = 0.02). This 50% reduction was the same when adjusted for centre and glycaemic control (0.55 [0.30-1.03], p = 0.06). Lisinopril also decreased progression by two or more grades (0.27 [0.07-1.00], p = 0.05), and progression to proliferative retinopathy (0.18 [0.04-0.82], p = 0.03). Progression was not associated with albuminuric status at baseline. Treatment reduced retinopathy incidence (0.69 [0.30-1.59], p = 0.4). INTERPRETATION: Lisinopril may decrease retinopathy progression in non-hypertensive patients who have type 1 diabetes with little or no nephropathy. These findings need to be confirmed before changes to clinical practice can be advocated.

Adult↗
PubMed1998

Mortality and morbidity from diabetes in South Asians and Europeans: 11-year follow-up of the Southall Diabetes Survey, London, UK.

Over 20% of middle aged and elderly South Asian people throughout the world have diabetes. The associated mortality and morbidity risks are unclear. We compared mortality and morbidity in a cohort of South Asian and European people with diabetes in London, UK, in an 11-year follow-up of a population-based sample of 730 South Asians (mean age 55 in 1984) and 304 Europeans (mean age 67 in 1984) with diabetes aged 30 years and above in 1984. By 1995, 242 (33%) of South Asians, and 172 (57%) of Europeans had died. The all-cause mortality rate ratio (South Asian versus European) was 1.50 (95% CI 0.72-3.12) for those aged 30-54 years at baseline. Ethnic differences in mortality rates were abolished or reversed in people aged 65 years and above at baseline. The mortality rate ratio for circulatory deaths was 1.80 (95% CI 1.03-3.16, p < 0.05) and for heart disease was 2.02 (95% CI 1.04-3.92, p < 0.05) in those aged 30-64 years at baseline. Seventy-seven per cent of South Asian deaths were caused by circulatory disease, compared with 46% of European deaths. South Asian survivors were 3.8 times (95% CI 1.8-8.0, p = 0.001) more likely to report a history of myocardial infarction than Europeans. South Asian adults with diabetes show a markedly increased predisposition to cardiovascular disease compared with Europeans, especially in younger people. This emphasizes the urgent need to reduce cardiovascular risk in this vulnerable group.

Adult↗
PubMed1998

Comparison of prevalence and risk factors for microalbuminuria in South Asians and Europeans with type 2 diabetes mellitus.

Although Type 2 (non-insulin-dependent) diabetes mellitus (Type 2 DM) is more common in South Asians than in Europeans in the UK, very little is known about complications and their risk factors in South Asians. We sought microalbuminuria in a cross-sectional study of 583 European and 889 South Asian Type 2 DM clinic attenders to Ealing Hospital, London, over 1 year. Albumin/creatinine ratios were measured in early morning urines. Prevalence of microalbuminuria was greater in South Asians compared to Europeans (40% versus 33% in men, p = 0.003, and 33% versus 19% in women, p < 0.0001). Glycaemic control was worse and prevalence of hypertension, retinopathy and heart disease was higher in South Asians. Key risk factors for microalbuminuria in both ethnic groups were glycaemic control, diabetes duration, blood pressure, triglyceride and retinopathy, but none accounted for the higher microalbuminuria prevalence in South Asians. Age and sex adjusted odds ratio for microalbuminuria was 1.78 (95% CI 1.02, 2.82, p = 0.02) in South Asians versus Europeans. After adjustment for confounders, this became 2.07, 95% CI 1.13, 3.79, p = 0.02. We conclude that microalbuminuria is more common in South Asians with Type 2 DM than in Europeans and, although risk factor relationships appeared similar in both groups, and some risk factors were more prominent in South Asians, this cannot account for the high prevalence of microalbuminuria observed in South Asians.

Age Factors↗
PubMed1998

The implementation of prompted retinal screening for diabetic eye disease by accredited optometrists in an inner-city district of North London: a quality of care study.

Diabetic retinopathy remains the most common cause of blindness in people of working age but the provision of high quality eye screening for diabetic patients is still erratic in many health districts in the UK. National consensus guidelines recommend comprehensive population coverage, high sensitivity (>80%), high specificity (>95%), agreed clinical criteria, referral procedures and centralized data collection to facilitate audit. This study looks at the effectiveness of implementing a prompted recall programme for retinal screening in an inner-city district of North London. The scheme uses trained, accredited optometrists to screen patients with diabetes who are looked after in the community by their general practitioner. During the first 17 months of the scheme, 63 optometrists attended training and gained accreditation. Of the 666 patients recruited, 645 were scheduled for screening and 536 (83%) attended. Fourteen per cent of patients screened were found to have background retinopathy and 2.3% sight-threatening eye disease. In two audits, carried out 15 months apart in a random sample of GP practices, the incidence of recorded dilated fundoscopy increased from 48% at baseline to 56%, an increase of 8% (95% CIs 2%-14%). For referable eye disease, the sensitivity of this screening technique was 100%, the specificity 94% (95% CIs 90%-98%), the positive predictive value 79% (95% CIs 72%-86%) and the negative predictive value 100%. The administrative cost per case screened was Pound Sterling 12.60 (excluding clinical costs and any additional optometry payment).

Diabetic Retinopathy↗
PubMed1998

Nitrate therapy may retard glaucomatous optic neuropathy, perhaps through modulation of glutamate receptors.

Nitrates have been a major part of the internist's pharmacopoeia for more than 100 years, predominantly for the relief of anginal symptoms. The effects of nitroglycerin on the eye and specifically on intraocular pressure has been investigated with diverse results. However, nitroglycerin may also serve to protect retinal ganglion cells against glutamate mediated toxicity--a form of cell death that may be critical in glaucomatous blindness. Consequently, we therefore sought to evaluate whether nitroglycerin preparations, taken for non-ophthalmic reasons, had an effect on glaucomatous damage.

Aged↗
PubMed1998

Gender differences in accessing cardiac surgery across England: a cross-sectional analysis of the health survey for England.

OBJECTIVE: To examine gender differences in access to cardiac surgery in a nationally representative sample. DESIGN: Nationwide cross sectional household based survey (Health Survey for England). SETTING: Private households in England around 1993 and 1994. SUBJECTS: 1708 subjects reporting a history of either doctor diagnosed angina or heart attack from a stratified random sample of 32 378 people aged 16 and above. OUTCOME MEASURE: The proportion reporting having had cardiac surgery or on a waiting list. RESULTS: 13.5% reported previous (n = 206) or pending (n = 25) cardiac surgery. Men were more likely than women to have had or to be waiting for cardiac surgery (19.1% of men versus 6.8% of women, chi2 54.7, P<0.001). This finding was consistent regardless of age group and across three regional areas. The unadjusted odds ratio for cardiac surgery for men versus women was 3.3 (95% Cl 2.3, 4.5, P<0.001) and was only slightly attenuated to 2.8 (95% CI 1.9, 4.0. P<0.001), after adjustment for other factors. The gender difference remained even when analysis was restricted to subjects reporting a previous heart attack, and after statistical adjustment for disease severity. CONCLUSION: Women are less likely than men to receive cardiac surgery across all age groups and regional areas. These results include private operations and adjust for individual behavioural data. Neither disease severity or co-morbidity explains these discrepancies. Further studies are required to determine why this inequality occurs and how it can be addressed.

Adolescent↗
PubMed1998

Effect of angiotensin-converting enzyme (ACE) gene polymorphism on progression of renal disease and the influence of ACE inhibition in IDDM patients: findings from the EUCLID Randomized Controlled Trial. EURODIAB Controlled Trial of Lisinopril in IDDM.

We examined whether the ACE gene insertion/deletion (I/D) polymorphism modulates renal disease progression in IDDM and how ACE inhibitors influence this relationship. The EURODIAB Controlled Trial of Lisinopril in IDDM is a multicenter randomized placebo-controlled trial in 530 nonhypertensive, mainly normoalbuminuric IDDM patients aged 20-59 years. Albumin excretion rate (AER) was measured every 6 months for 2 years. Genotype distribution was 15% II, 58% ID, and 27% DD. Between genotypes, there were no differences in baseline characteristics or in changes in blood pressure and glycemic control throughout the trial. There was a significant interaction between the II and DD genotype groups and treatment on change in AER (P = 0.05). Patients with the II genotype showed the fastest rate of AER progression on placebo but had an enhanced response to lisinopril. AER at 2 years (adjusted for baseline AER) was 51.3% lower on lisinopril than placebo in the II genotype patients (95% CI, 15.7 to 71.8; P = 0.01), 14.8% in the ID group (-7.8 to 32.7; P = 0.2), and 7.7% in the DD group (-36.6 to 37.6; P = 0.7). Absolute differences in AER between placebo and lisinopril at 2 years were 8.1, 1.7, and 0.8 microg/min in the II, ID, and DD groups, respectively. The significant beneficial effect of lisinopril on AER in the II group persisted when adjusted for center, blood pressure, and glycemic control, and also for diastolic blood pressure at 1 month into the study. Progression from normoalbuminuria to microalbuminuria (lisinopril versus placebo) was 0.27 (0.03-2.26; P = 0.2) in the II group, and 1.30 (0.33-5.17; P = 0.7) in the DD group (P = 0.6 for interaction). Knowledge of ACE genotype may be of value in determining the likely impact of ACE inhibitor treatment.

Adult↗
PubMed1997

Lay diagnosis and health-care-seeking behaviour for chest pain in south Asians and Europeans.

BACKGROUND: South Asian people in the UK experience greater delays than Europeans in obtaining appropriate specialist management for heart disease, but the causes are not known. We investigated whether south Asians and Europeans interpret and act upon anginal symptoms differently. METHODS: We randomly selected 2000 people from general practitioners' (family physicians) lists in London, UK, to receive a questionnaire that included a short fictional case history of an individual with possible anginal pain and asked how respondents would react to experiencing it. A second questionnaire seeking information on medical history, attitudes to health, and demography was sent later. The main outcome measure was the proportion who said they would seek immediate care (hospital emergency department or general practitioner) for the pain described in the case scenario. FINDINGS: The rate of response to both questionnaires was 60.2% (903 of 1500 who received both), 553 responders were of European origin, 124 were Hindu, and 235 were Sikh. There were no differences between the ethnic groups in the proportion identifying the pain as cardiac, but south Asians would be more anxious about the pain than would Europeans. Of the men, 55 (23%) Europeans, 20 (38%) Hindus, and 52 (47%) Sikhs said they would seek immediate care (p < 0.0001 for heterogeneity); of women, 77 (24%), 25 (35%), and 58 (46%), respectively, would seek immediate care (p < 0.0001). After adjustment for confounding variables the odds ratio for seeking immediate care in Hindus compared with Europeans was 2.67 (95% CI 1.49-4.73) and that for Sikhs compared with Europeans was 3.18 (1.98-5.12). INTERPRETATION: Hindus and Sikhs reported a greater likelihood of seeking immediate care for anginal symptoms than Europeans; this finding indicates that barriers to cardiology services for south Asians are unrelated to difficulties in interpretations of symptoms or willingness to seek care. Improvement of awareness of heart disease may not decrease delays in obtaining care. Service-related explanations must be explored, such as general practitioners' difficulties in arriving at a diagnosis or differences in management because of ethnic origin.

Adult↗
PubMed1997

Which features of smoking determine mortality risk in former cigarette smokers with diabetes? The World Health Organization Multinational Study Group.

OBJECTIVE: The effects of quitting smoking on mortality risk in individuals with diabetes is unknown and may differ from the benefits observed in the general population. We therefore determined the mortality risks in ex-smokers with diabetes, compared with subjects who have never smoked, by the number of years since quitting, the number of cigarettes smoked, and the number of years of smoking. RESEARCH DESIGN AND METHODS: An international cohort study of 4,427 individuals with diabetes was studied. Baseline examinations were performed in 1975-1977 when smoking habits were determined by questionnaire. Mortality follow-up continued until 1988. RESULTS: All-cause mortality risks were higher for recent quitters (1-9 years; relative risk [RR], 1.53 [95% CI 1.19-1.97]; P = 0.001) than for those who quit earlier (> or = 10 years; RR, 1.25 [95% CI 1.03-1.52]; P = 0.02), compared with subjects who have never smoked. These risks were highest in those who had smoked the longest (> or = 30 years: RR, 1.66 [95% CI 1.22-2.26]; P = 0.001; vs. 1-9 years: RR, 1.17 [95% CI 0.85-1.60]; P = 0.3). Risks were also highest in those who had smoked the most and least number of cigarettes. Adjustment for key confounders, which included a previous history of heart disease, proteinuria, and blood pressure, did not materially affect these relationships. CONCLUSIONS: Quitting smoking does reduce mortality risk in ex-smokers with diabetes, but risks remain high several years after quitting and are highly dependent on the duration of smoking. Thus, individuals with diabetes who smoke should be encouraged to quit as soon as possible in the course of disease.

Adult↗
PubMed1997

Angiotensin converting enzyme inhibitors in diabetic patients with microalbuminuria or normoalbuminuria.

In adult diabetic patients microalbuminuria is a marker of early vascular damage in the micro- and macrocirculation. Microalbuminuria is a powerful predictor of renal and cardiovascular disease outcome and is associated with other, potentially modifiable, risk factors of vascular damage. Studies of secondary prevention have shown that blood pressure lowering drugs effectively reduce albumin excretion rate. Angiotensin converting enzyme (ACE) inhibitors seem particularly effective in reducing the risk of progression to clinical albuminuria in both insulin dependent and non-insulin dependent diabetic patients and this beneficial effect appears to be long-lasting. Whether this postpones the onset of end-stage renal failure and/or reduces early mortality in these patients remains to be established. Recent studies of primary prevention in insulin-dependent diabetic patients predominantly with normoalbuminuria demonstrate that ACE inhibition reduces significantly the rate of progression of albumin excretion rate and, of great interest, seems to affect beneficially the progression of retinopathy. These results compare favorably with the beneficial effect of intensified insulin therapy and strict blood glucose control in this same group of patients. Thus, ACE inhibitors are a powerful tool to prevent progression of microalbuminuria in diabetes and may prove useful as an adjunct therapy to intensified insulin therapy in the prevention of development of microalbuminuria and of retinopathy progression in insulin dependent diabetes.

Adult↗
PubMed1996

Differences in mortality and morbidity in African Caribbean and European people with non-insulin dependent diabetes mellitus: results of 20 year follow up of a London cohort of a multinational study.

OBJECTIVE: To examine differences in morbidity and mortality due to non-insulin dependent diabetes in African Caribbeans and Europeans. DESIGN: Cohort study of patients with non-insulin dependent diabetes drawn from diabetes clinics in London. Baseline investigations were performed in 1975-7; follow up continued until 1995. PATIENTS: 150 Europeans and 77 African Caribbeans with non-insulin dependent diabetes. MAIN OUTCOME MEASURES: All cause and cardiovascular mortality; prevalence of microvascular and macrovascular complications. RESULTS: Duration of diabetes was shorter in African Caribbeans, particularly women. African Caribbeans were more likely than the Europeans to have been given a diagnosis after the onset of symptoms and less likely to be taking insulin. Mean cholesterol concentration was lower in African Caribbeans, but blood pressure and body mass index were not different in the two ethnic groups. Prevalence of microvascular and macrovascular complications was insignificantly lower in African Caribbens than in Europeans. 59 Europeans and 16 African Caribbeans had died by the end of follow up. The risk ratio for all cause mortality was 0.41 (95% confidence interval 0.23 to 0.73) (P = 0.002) for African Caribbeans v Europeans. This was attenuated to 0.59 (0.32 to 1.10) (P = 0.1) after adjustment for sex, smoking, proteinuria, and body mass index. Further adjustment for systolic blood pressure, cholesterol concentration, age, duration of diabetes, and treatment made little difference to the risk ratio. Unadjusted risk ratio for cardiovascular and ischaemic heart disease were 0.33 (0.15 to 0.70) (P = 0.004) and 0.37 (0.16 to 0.85) (P = 0.02) respectively. CONCLUSIONS: African Caribbeans with non-insulin dependent diabetes maintain a low risk of heart disease. Management priorities for diabetes developed in one ethnic group may not necessarily be applicable to other groups.

Adult↗