Insulin and Higher Odds of a Positive History of Cardiovascular Disease Among Diabetic Individuals

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality in the United States. While diabetes increases the risk and complications of CVD, it remains unclear the degree to which aspects of diabetes management such as insulin and lifestyle factors play a role on its occurrence. This study examined associations between positive history of CVD (stroke, heart attack, and/or myocardial infarction) and insulin, socio-demographic, and psychological determinants.

METHODS: Data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed for 9,506 self-reported diabetic survey participants aged ≥18 years. Both weighted multivariable and multinomial logistic regression models assessed history of CVD.

RESULTS: The adjusted multivariable model revealed that the odds of a positive self-reported history of CVD were 1.43 (95% CI: 1.22-1.68) times higher among individuals who reported using insulin compared to those who were not. Older individuals (aged ≥ 55 years) had higher odds (aOR = 2.72; 95% CI: 1.30-5.67) of a positive self-reported history of CVD compared to younger peers (aged 18-24 years). Furthermore, males had higher odds compared to females (OR = 1.35; 95% CI: 1.15-1.60). Interestingly, alcohol users had 21.2% (aOR = 0.79; 95%: 0.66-0.95) lower odds of a positive self-reported history of CVD compared lifetime abstainers. Although positive self-reported frequent mental distress (14 or more mentally unhealthy days) (aOR = 1.11; 95% 0.89-1.39) and depression (aOR = 1.10; 95% CI: 0.91-1.33) both increased the odds of a positive self-reported history of CVD, only self-reported physical health (30 days of physical health not good) was statistically significant (aOR = 1.64; 95% CI:1.40-1.93).The adjusted multinomial logistic regression model showed that, compared to individuals without a history of CVD, insulin users had  higher odds of self-reporting coronary heart disease (CHD) (aOR = 1.53; 95% CI: 1.22-1.68). Moreover, insulin users had 8% lower odds of self-reporting stroke, (aOR = 0.92; 95%CI: 0.69-1.24) and had 1.30 times (OR = 1.30; 95% CI: 0.94-1.80) higher odds of self-reporting myocardial infarction but such trend were not statistically significant.

CONCLUSIONS: Self-reported diabetic individuals who use insulin had higher odds of a self-reported history of CVD, particularly coronary heart disease. Furthermore, other lifestyle factors continue to show their importance in CVD prevalence. A better understanding of the impact of lifestyle factors and diabetes management can help tackle current CVD epidemic in the United States. Future research should determine whether other medical and cardiometabolic mechanisms interact with insulin to better understand cardiovascular disease outcomes.