Open Access Open Badges Original investigation

Metabolic predictors of ischemic heart disease and cerebrovascular attack in elderly diabetic individuals: difference in risk by age

Toshio Hayashi1*, Atsushi Araki2, Seinosuke Kawashima3, Hirohito Sone4, Hiroshi Watanabe5, Takashi Ohrui6, Koutaro Yokote7, Minoru Takemoto7, Kiyoshi Kubota8, Mitsuhiko Noda9, Hiroshi Noto9, Koichiro Ina1, Hideki Nomura110 and on behalf of Japan CDM group

Author Affiliations

1 Department of Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Japan

2 Division of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan

3 Osaka Saiseikai Nakatsu Hospital, Osaka, Japan

4 Department of Internal Medicine, Endocrinology and Metabolism, Niigata Graduate School of Medicine, Niigata, Japan

5 Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan

6 Department of Geriatric Medicine, Tohoku University School of Medicine, Sendai, Japan

7 Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Chiba University Hospital, Chiba, Japan

8 Department of Pharmacoepidemiology, Faculty of Medicine, University of Tokyo, Tokyo, Japan

9 Department of Diabetes and Metabolic Medicine, National Center for Global Health and Medicine, Tokyo, Japan

10 Department of Geriatrics, Nagoya Kita Hospital, Nagoya, Japan

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Cardiovascular Diabetology 2013, 12:10  doi:10.1186/1475-2840-12-10

Published: 9 January 2013



High LDL-cholesterol (LDL-C) and glucose levels are risk factors for ischemic heart disease (IHD) in middle-aged diabetic individuals; however, the risk among the elderly, especially the very elderly, is not well known. The aim of this study was to identify factors that predict IHD and cerebrovascular attack (CVA) in the elderly and to investigate their differences by age.


We performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study) with 5.5 years of follow-up. A total of 4,014 patients with type 2 diabetes and without previous IHD or CVA (1,936 women; age 67.4 ± 9.5 years, median 70 years; <65 years old, n = 1,261; 65 to 74 years old, n = 1,731; and ≥ 75 years old, n = 1,016) were recruited on a consecutive outpatient basis from 40 hospitals throughout Japan. Lipids, glucose, and other factors related to IHD or CVA risk, such as blood pressure (BP), were investigated using the multivariate Cox hazard model.


One hundred fifty-three cases of IHD and 104 CVAs (7.8 and 5.7/1,000 people per year, respectively) occurred over 5.5 years. Lower HDL-cholesterol (HDL-C) and female gender were correlated with IHD in patients ≥75 years old (hazard ratio (HR):0.629, P < 0.01 and 1.132, P < 0.05, respectively). In contrast, systolic BP (SBP), HbA1C, LDL-C and non-HDL-C were correlated with IHD in subjects <65 years old (P < 0.05), and the LDL-C/HDL-C ratio was correlated with IHD in all subjects. HDL-C was correlated with CVA in patients ≥75 years old (HR: 0.536, P < 0.01). Kaplan-Meier estimator curves showed that IHD occurred more frequently in patients <65 years old in the highest quartile of the LDL-C/HDL-C ratio. In patients ≥75 years old, IHD and CVA were both the most frequent among those with the lowest HDL-C levels.


IHD and CVA in late elderly diabetic patients were predicted by HDL-C. LDL-C, HbA1C, SBP and non-HDL-C are risk factors for IHD in the non-elderly. The LDL-C/HDL-C ratio may represent the effects of both LDL-C and HDL-C. These age-dependent differences in risk are important for developing individualized strategies to prevent atherosclerotic disease.

Trial registration

UMIN-CTR, UMIN00000516

Elderly; Diabetes mellitus; Cardiovascular diseases; HDL-C; LDL-C/HDL-C ratio