Background
Methods
Study populations
The SHIP-TREND study (Northeast of Germany)
The KORA-F4 study (South of Germany)
Variables
Macrovascular disease
Diabetes and glucose tolerance
Medical data
Hypertension and hyperlipidemia
Educational level
Physical activity
Smoking
Study sample
Statistical analyses
Results
Participants’ characteristics stratified by cohort and diabetes status
SHIP-TREND | KORA-F4 | p-value | |
---|---|---|---|
N | 2539 | 2932 | |
Age (years) | 53.9 (12.9) | 55.7 (12.8) |
< 0.001
|
Female sex (%) | 52.8 | 51.6 | 0.373 |
Middle/low education (%) | 73.5 | 76.3 |
0.021
|
Age at diagnosis of diabetes (years)a | 55.2 (10.5) | 59.1 (10.1) |
< 0.001
|
Body mass index (kg/m2) | 28.6 (5.3) | 27.6 (4.8) |
< 0.001
|
No physical activity (%) | 48.6 | 45.0 |
0.009
|
Current smoking (%) | 19.6 | 16.6 | 0.064 |
Ex-smoking (%) | 21.4 | 26.5 |
0.001
|
Systolic blood pressure (mmHg) | 127.7 (18.2) | 122.2 (18.6) |
< 0.001
|
Diastolic blood pressure (mmHg) | 77.3 (10.0) | 75.2 (10.0) |
< 0.001
|
Hypertension in general population (%) | 52.9 | 50.8 | 0.125 |
Self-reported high blood pressure (ever) (%) | 48.9 | 48.6 | 0.823 |
Antihypertensive medication (%) | 38.4 | 29.8 |
< 0.001
|
Hypertension in known diabetes (%)a | 88.9 | 88.2 | 0.782 |
Self-reported high blood pressure (ever) (%) | 80.0 | 84.8 | 0.141 |
Antihypertensive medication (%) | 79.2 | 75.1 | 0.237 |
Hyperlipidemia in general population (%) | 27.6 | 30.5 |
0.020
|
Self-reported high lipid levels (last 12 months) (%) | 24.5 | 28.2 |
0.002
|
Lipid-lowering medication (%) | 14.2 | 12.3 |
0.042
|
Hyperlipidemia in known diabetes (%)a | 59.6 | 59.5 | 0.988 |
Self-reported high lipid levels (last 12 months) (%) | 46.0 | 48.6 | 0.539 |
Lipid-lowering medication (%) | 41.8 | 39.2 | 0.529 |
Macrovascular disease in general population (%) | 12.0 | 8.8 |
< 0.001
|
Myocardial infarction (%) | 2.9 | 2.9 | 0.976 |
Stroke (%) | 1.5 | 1.0 | 0.052 |
Coronary angiography (%)b | 8.6 | 5.2 |
< 0.001
|
Macrovascular disease in known diabetes (%)a | 32.8 | 24.9 |
0.040
|
Myocardial infarction (%) | 9.4 | 11.0 | 0.544 |
Stroke (%) | 4.7 | 2.5 | 0.172 |
Coronary angiography (%)b | 22.2 | 12.3 |
0.002
|
Fasting glucose (mmol/l)c | 5.5 (0.8) | 5.3 (0.6) |
< 0.001
|
2-h glucose (mmol/l)c | 6.6 (2.4) | 6.2 (2.0) |
< 0.001
|
HbA1c (%) | 5.46 (0.89) | 5.55 (0.61) |
< 0.001
|
HbA1c (mmol/mol) | 36.1 (9.7) | 37.1 (6.7) |
< 0.001
|
HOMA-IRd | 2.5 (1.6–3.8) | 2.0 (1.4–3.0) |
< 0.001
|
Total cholesterol (mmol/l) | 5.5 (1.1) | 5.6 (1.0) |
0.009
|
HDL-cholesterol (mmol/l) | 1.4 (0.4) | 1.4 (0.4) | 0.167 |
LDL-cholesterol (mmol/l) | 3.4 (0.9) | 3.5 (0.9) |
< 0.001
|
Triglycerides (mmol/l) | 1.3 (0.9–1.9) | 1.2 (0.8–1.7) |
< 0.001
|
hsCRP (mg/l)e | 1.2 (0.7–2.6) | 1.1 (0.6–2.4) |
< 0.001
|
eGFR (ml/min/1.73 m2) | 86.9 (20.1) | 88.3 (16.5) |
0.005
|
Normal glucose tolerance | Prediabetes | Newly diagnosed diabetes | Known diabetes | |
---|---|---|---|---|
Total % (n) | ||||
KORA-F4 | 60.5 (1774) | 28.4 (834) | 3.0 (87) | 8.1 (237) |
SHIP-TREND | 45.3 (1151) | 34.9 (885) | 5.6 (142) | 14.2 (361) |
Age (years) mean (std) | ||||
KORA-F4 |
51.5 (12.2)
|
60.6 (11.3)
| 64.8 (9.7) |
66.9 (8.6)
|
SHIP-TREND |
48.6 (12.3)
|
55.2 (11.7)
| 61.6 (9.3) |
65.0 (9.3)
|
Body mass index (kg/m2) mean (SD) | ||||
KORA-F4 | 26.3 (4.3) | 29.1 (4.7) | 31.1 (4.4) |
31.5 (5.4)
|
SHIP-TREND | 26.3 (4.3) | 29.3 (4.7) | 31.3 (5.2) |
33.0 (5.8)
|
Systolic blood pressure (mmHg) mean (SD) | ||||
KORA-F4 |
117.4 (16.9)
|
128.1 (18.5)
| 132.6 (16.8) |
132.7 (19.6)
|
SHIP-TREND |
121.0 (15.7)
|
130.7 (16.8)
| 135.7 (19.3) |
138.5 (19.9)
|
Diastolic blood pressure (mmHg) mean (SD) | ||||
KORA-F4 |
74.2 (9.6)
|
77.3 (10.2)
| 77.9 (10.5) |
74.6 (10.5)
|
SHIP-TREND |
75.3 (9.4)
|
79.3 (9.7)
| 79.1 (10.8) |
78.4 (10.8)
|
Fasting glucose (mmol/l) | ||||
KORA-F4 |
5.0 (0.3)
|
5.7 (0.5)
|
6.7 (1.3)
| NA |
SHIP-TREND |
5.1 (0.3)
|
5.9 (0.4)
|
7.3 (1.8)
| NA |
2-h glucose (mmol/l) | ||||
KORA-F4 |
5.3 (1.1)
|
7.3 (1.8)
| 12.0 (2.8) | NA |
SHIP-TREND |
5.5 (1.1)
|
7.1 (1.7)
| 12.6 (3.5) | NA |
HbA1c (%) mean (SD) | ||||
KORA-F4 |
5.3 (0.3)
|
5.6 (0.3)
| 6.1 (0.7) | 6.8 (1.1) |
SHIP-TREND |
5.1 (0.5)
|
5.3 (0.5)
| 5.9 (1.0) | 6.7 (1.3) |
HbA1c (mmol/mol) mean (SD) | ||||
KORA-F4 |
34.7 (3.2)
|
37.6 (3.7)
| 43.2 (7.6) | 51.1 (12.5) |
SHIP-TREND |
32.3 (5.9)
|
34.7 (5.6)
| 41.1 (10.8) | 49.8 (13.7) |
HOMA-IR median (IQR) | ||||
KORA-F4 |
1.7 (1.2–2.3)
|
2.8 (2.0–4.2)
| 5.3 (3.2–7.3) | 5.2 (3.5–8.1) |
SHIP-TREND |
1.9 (1.3–2.6)
|
3.2 (2.3–4.6)
| 5.9 (3.7–8.4) | NA |
HDL-cholesterol (mmol/l) mean (SD) | ||||
KORA-F4 | 1.5 (0.4) | 1.4 (0.4) | 1.3 (0.3) | 1.2 (0.3) |
SHIP-TREND | 1.5 (0.4) | 1.4 (0.3) | 1.3 (0.4) | 1.2 (0.3) |
Triglycerides (mmol/l) median (IQR) | ||||
KORA-F4 |
1.0 (0.7–1.5)
| 1.4 (1.0–2.0) | 1.8 (1.2–2.6) |
1.6 (1.1–2.3)
|
SHIP-TREND |
1.1 (0.8–1.5)
| 1.4 (1.1–2.0) | 1.9 (1.3–2.8) |
2.1 (1.5–3.0)
|
hsCRP (mg/l)a median (IQR) | ||||
KORA-F4 |
0.9 (0.5–1.9)
| 1.4 (0.7–2.7) | 2.8 (1.2–4.7) | 1.8 (0.9–3.2) |
SHIP-TREND |
1.0 (0.6–2.1)
| 1.3 (0.7–2.5) | 1.9 (0.9–3.7) | 2.1 (1.0–4.2) |
Macrovascular disease % (n) | ||||
KORA-F4 | 5.3 (94) | 11.1 (92) | 12.6 (11) | 24.9 (59) |
SHIP-TREND | 6.1 (70) | 10.0 (88) | 19.7 (28) | 32.8 (118) |
Regional differences and risk factors of macrovascular disease
Variable | Macrovascular disease (yes vs. no) Known diabetes | Macrovascular disease (yes vs. no) General population | ||
---|---|---|---|---|
OR (95% Cl) | p-value | OR (95% Cl) | p-value | |
Model A | ||||
SHIP-TREND (vs. KORA-F4) |
1.66 (1.14–2.43)
|
0.009
|
1.76 (1.46–2.12)
|
< 0.001
|
Men (vs. women) |
1.73 (1.18–2.52)
|
0.005
|
2.20 (1.81–2.67)
|
< 0.001
|
Age (per year, continuous) |
1.05 (1.03–1.07)
|
< 0.001
|
1.09 (1.08–1.10)
|
< 0.001
|
Model B | ||||
SHIP-TREND (vs. KORA-F4) |
1.70 (1.11–2.62)
|
0.015
|
1.78 (1.44–2.19)
|
< 0.001
|
Men (vs. women) | 1.50 (0.93–2.41) | 0.098 |
1.97 (1.57–2.47)
|
< 0.001
|
Age (per year, continuous) |
1.05 (1.02–1.08)
|
0.001
|
1.07 (1.05–1.08)
|
< 0.001
|
BMI ≥ 25 kg/m2 (vs. < 25 kg/m2) | 2.55 (0.85–7.65) | 0.096 |
1.39 (1.01–1.93)
|
0.046
|
BMI ≥ 30 kg/m2 (vs. < 25 kg/m2) | 1.91 (0.65–5.64) | 0.241 | 1.14 (0.80–1.61) | 0.466 |
hsCRP (mg/l)a (continuous) | 1.15 (0.90–1.47) | 0.254 | 1.04 (0.92–1.17) | 0.534 |
Hypertension (vs. no) | 2.35 (0.94–5.88) | 0.069 |
3.47 (2.57–4.68)
|
< 0.001
|
Hyperlipidemia (vs. no) |
3.86 (2.41–6.18)
|
< 0.001
|
3.34 (2.70–4.14)
|
< 0.001
|
Smoker (vs. never smoker) | 1.47 (0.73–2.97) | 0.278 | 1.16 (0.81–1.64) | 0.417 |
Ex-smoker (vs. never-smoker) | 1.58 (0.98–2.55) | 0.061 |
1.45 (1.15–1.84)
|
0.002
|
Low/middle education (vs. high education) | 0.92 (0.51–1.64) | 0.767 | 1.22 (0.94–1.59) | 0.134 |
< 1 h physical activity (vs. > 1 h) | 0.96 (0.62–1.47) | 0.837 | 1.01 (0.82–1.24) | 0.945 |
Model C | ||||
SHIP-TREND (vs. KORA-F4) |
1.66 (1.11–2.49)
|
0.014
|
1.63 (1.33–2.00)
|
< 0.001
|
Men (vs. women) | 1.49 (0.97–2.29) | 0.070 |
1.89 (1.52–2.34)
|
< 0.001
|
Age (per year, continuous) |
1.05 (1.02–1.08)
|
0.001
|
1.06 (1.05–1.08)
|
< 0.001
|
BMI ≥ 25 kg/m2 (vs. < 25 kg/m2) | 1.85 (0.67–5.10) | 0.237 |
1.39 (1.01–1.92)
|
0.041
|
BMI ≥ 30 kg/m2 (vs. < 25 kg/m2) | 1.72 (0.64–4.66) | 0.287 | 1.15 (0.82–1.61) | 0.419 |
Hypertension (vs. no) |
2.79 (1.13–6.87)
|
0.026
|
3.48 (2.59–4.68)
|
< 0.001
|
Hyperlipidemia (vs. no) |
3.48 (2.25–5.36)
|
< 0.001
|
3.16 (2.57–3.88)
|
< 0.001
|
Smoker (vs. never smoker) | 1.27 (0.66–2.45) | 0.477 | 1.10 (0.79–1.54) | 0.572 |
Ex-smoker (vs. never-smoker) | 1.51 (0.97–2.34) | 0.066 |
1.48 (1.18–1.86)
|
0.001
|
Known diabetes (vs. normal glucose tolerance) | – | – |
1.37 (1.03–1.84)
|
0.033
|
Prediabetes (vs. normal glucose tolerance) | – | – | 0.86 (0.67–1.10) | 0.226 |
Newly diagnosed diabetes (vs. normal glucose tolerance) | – | – | 0.99 (0.64–1.52) | 0.950 |
Sensitivity analyses
Variable | Myocardial infarction or stroke (yes vs. no) Known diabetesa | Myocardial infarction or stroke (yes vs. no) General populationb | ||
---|---|---|---|---|
OR (95% Cl) | p-value | OR (95% Cl) | p-value | |
Model A | ||||
SHIP-TREND (vs. KORA-F4) | 1.14 (0.69–1.89) | 0.600 |
1.34 (1.01–1.78)
|
0.004
|
Men (vs. women) |
2.05 (1.20–3.51)
|
0.009
|
2.58 (1.90–3.51)
|
< 0.001
|
Age (per year, continuous) |
1.07 (1.04–1.11)
|
< 0.001
|
1.10 (1.09–1.12)
|
< 0.001
|
Model B | ||||
SHIP-TREND (vs. KORA-F4) | 1.09 (0.62–1.94) | 0.764 | 1.31 (0.95–1.79) | 0.098 |
Men (vs. women) | 1.92 (0.96–3.84) | 0.065 |
2.30 (1.60–3.31)
|
< 0.001
|
Age (per year, continuous) |
1.10 (1.05–1.14)
|
< 0.001
|
1.08 (1.06–1.10)
|
< 0.001
|
BMI ≥ 25 kg/m2 (vs. < 25 kg/m2) | 1.53 (0.38–6.23) | 0.555 | 1.08 (0.66–1.80) | 0.753 |
BMI ≥ 30 kg/m2 (vs. < 25 kg/m2) | 1.60 (0.40–6.36) | 0.506 | 0.93 (0.55–1.58) | 0.782 |
hsCRP (mg/l)c (continuous) | 1.30 (0.93–1.81) | 0.121 | 1.09 (0.91–1.31) | 0.344 |
Hypertension (vs. no) | 1.29 (0.35–4.67) | 0.703 | 3.58 (2.08–6.19) |
< 0.001
|
Hyperlipidemia (vs. no) |
4.27 (2.08–8.77)
|
< 0.001
| 4.76 (3.31–6.85) |
< 0.001
|
Smoker (vs. never smoker) |
2.93 (1.18–7.27)
|
0.021
|
1.96 (1.17–3.29)
|
0.012
|
Ex-smoker (vs. never-smoker) | 1.48 (0.77–2.86) | 0.243 |
1.69 (1.18–2.42)
|
0.004
|
Low/middle education (vs. high education) | 1.17 (0.52–2.64) | 0.699 |
1.68 (1.08–2.61)
|
0.022
|
< 1 h physical activity (vs. > 1 h) | 0.80 (0.45–1.43) | 0.451 | 1.16 (0.85–1.60) | 0.355 |
Model C | ||||
SHIP-TREND (vs. KORA-F4) | 1.11 (0.66–1.87) | 0.689 | 1.21 (0.89–1.64) | 0.229 |
Men (vs. women) | 1.74 (0.96–3.16) | 0.071 |
2.23 (1.58–3.14)
|
< 0.001
|
Age (per year, continuous) |
1.08 (1.04–1.12)
|
< 0.001
|
1.08 (1.06–1.09)
|
< 0.001
|
Hypertension (vs. no) | 2.07 (0.61–7.08) | 0.245 |
3.32 (1.99–5.56)
|
< 0.001
|
Hyperlipidemia (vs. no) |
4.28 (2.21–8.26)
|
< 0.001
|
4.74 (3.35–6.72)
|
< 0.001
|
Smoker (vs. never smoker) | 1.89 (0.82–4.35) | 0.136 |
1.72 (1.05–2.81)
|
0.031
|
Ex-smoker (vs. never-smoker) | 1.35 (0.76–2.42) | 0.311 |
1.62 (1.16–2.27)
|
0.005
|
Low/middle education (vs. high education) | 1.43 (0.66–3.13) | 0.369 |
1.70 (1.12–2.58)
|
0.013
|
Known diabetes (vs. normal glucose tolerance) | – | – | 1.37 (0.91–2.06) | 0.130 |
Prediabetes (vs. normal glucose tolerance) | – | – | 0.93 (0.63–1.36) | 0.696 |
Newly diagnosed diabetes (vs. normal glucose tolerance) | – | – | 0.94 (0.49–1.81) | 0.862 |