Multi-Factorial Prevention of Cardiovascular Disease and Novel Markers of Risk in Early Glucose Disorders - The Addition-Leicester Study

Introduction - Screening followed by intensive multi-factorial cardiovascular risk intervention may improve outcomes in type 2 diabetes. It is unknown whether this is achievable or clinically effective within ethnically diverse United Kingdom populations. By preventing deleterious sub-clinical arteriosclerosis and inflammation, earlier identification of glucose disorders may be particularly beneficial within high-risk south Asian groups. Aims - To describe the rationale, design and results of a major multiethnic screening programme for type 2 diabetes, including a detailed characterisation of novel and traditional cardiovascular risk markers at baseline and one year after a controlled trial of multi-factorial intervention in screen detected cases. Results - 6749 individuals were screened with a glucose-tolerance test and 632 (9%) had an Arterial Stiffness (AS) assessment. 1480 (22%) were south Asian, 885 (18%) had abnormal glucose regulation and 196 (3.3%) had undiagnosed type 2 diabetes. Untreated cardiovascular disease risk and premature AS were significantly higher in all three of these groups compared with comparable white European and normoglycaemic controls. Vitamin D status was independently associated with AS in south Asians. Modelled cardiovascular outcomes and surrogate measures of inflammation (CRP) were improved by multi-factorial intervention but AS was not. Conclusion - Screening for diabetes is feasible in United Kingdom multiethnic populations and identifies people at high risk of cardiovascular disease. The prevalence of undiagnosed glucose abnormalities remains high. AS is manifest in screen-detected diabetes and unlike modelled vascular outcomes and inflammation is not ameliorated by multi-factorial intervention at one year. Vitamin D may be an important, treatable determinant of AS in south Asians.