ETSU Faculty and Alumni Publish on Cardiovascular Risk Factors and Diabetes

Dr. Hadii Mamudu, Associate Professor for the Department of Health Services Management and Policy in the East Tennessee State University (ETSU) College of Public Health, is lead author on an article in the Journal of Diabetes and Vascular Disease Research.  The article, Diabetes, subclinical atherosclerosis and multiple cardiovascular risk factors in hard-to-reach asymptomatic patients, examines the association of cardiovascular disease risk factors with and their cumulative effect on coronary artery calcium in patients with diabetes.

Co-authors include Drs. Arsham Alamian and Liang Wang, along with Pooja Subedi and Ali Alamin, of the ETSU College of Public Health.  Additional co-authors include Dr. Antwan Jones of The George Washington University, Dr. Timir Paul of the ETSU James H. Quillen College of Medicine, Dr. David Stewart of ETSU Bill Gatton College of Pharmacy, Dr. Gerald Blackwell of Ballad Health, and Dr. Matthew Budoff of the Los Angeles Biomedical Research Institute.

Diabetes is widely recognized as an independent risk factor for the development of clinical atherosclerotic CVD and was historically recognized as a cardiovascular risk equivalent although not all patients with diabetes appear to be at equal risk.  The prevalence of diabetes in the United States is, not uniform as major disparities exist across population subgroups and geographic areas.  Particularly, the Appalachian region is considered as the ‘Diabetes Belt’ due to a disproportionately high burden of the disease.

Of the 644 counties in the ‘Diabetes Belt’, 232 are in Appalachia, including a majority of the Central Appalachian counties.  Studies have found that residents in distressed Appalachian counties had a 33% higher risk of reporting diabetes than residents of non-Appalachian counties.  In addition, people in distressed or at-risk counties (the least economically developed) were diagnosed for diabetes at an earlier age, by 2–3 years, than in non-Appalachian counties.  Rural areas, such as Central Appalachia, have a higher diabetes prevalence relative to urban areas and the remainder of the United States as a whole, suggesting that research in subclinical atherosclerosis in patients with diabetes in this region is critical to achieve the Healthy People 2020 goals for reducing health disparities.

The study population consisted of 3000 asymptomatic individuals from the Central Appalachian region of Southeast Kentucky, Western North Carolina, Northeast Tennessee and Southwest Virginia who had participated in a screening program at the largest cardiovascular center in the region between August 2012 and December 2016.  In total, nearly 59% of the study population had subclinical atherosclerosis (as measured by having a coronary artery calcium score of 1), and about 14% had diabetes. The prevalence of subclinical atherosclerosis was higher among subjects with diabetes (68.5%) than those without diabetes (55.8%). 

Compared to subjects without diabetes and without presence of subclinical atherosclerosis, having 5 risk factors (including obesity, hypercholesterolaemia, hypertension, smoking, sedentary lifestyle, and family history of CVD) increased the odds of the presence of subclinical atherosclerosis in subjects with diabetes by 47 times. Findings of this study suggest the need for awareness about subclinical atherosclerosis in patients with diabetes and more research about coronary artery calcium in subpopulations of patients.