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Tobacco exposure & subclinical atherosclerosis in NIDDM

Institution: University of Southern California
Investigator(s): Wendy Mack, Ph.D.
Award Cycle: 2000 (Cycle 9) Grant #: 9RT-0031 Award: $321,363
Subject Area: Epidemiology
Award Type: Research Project Awards

Initial Award Abstract
Because of complications which affect the vascular system (blood vessels), cardiovascular disease is the major cause of illness and death among persons with diabetes. Non-insulin dependent diabetes mellitus (NIDDM) comprises over 90% of all diabetes, and Hispanic-Americans are at particular risk for developing NIDDM. Epidemiologic data suggest that the well-established effects of active smoking on cardiovascular mortality and total mortality is greater in diabetic subjects, compared to non-diabetic individuals. Diabetes and smoking may act together to cause particularly severe atherosclerosis, or damage to the arteries. Among persons without diabetes, both active smoking and exposure to environmental tobacco smoke (ETS) increase atherosclerotic damage to the arteries. This damage is seen in thickening of the walls of the artery and increased stiffness of the arteries. The relationship between tobacco exposures and these measures of atherosclerosis and progression of atherosclerosis has not been well-studied in persons with diabetes. We propose to use data from a clinical trial conducted among 299 adults (91% Hispanic) with NIDDM. This trial tested the effects of troglitazone, an insulin-sensitizing agent vs. placebo on the progression of atherosclerosis, and will be completed in June, 2000. In addition to an extensive battery of laboratory, clinical, and lifestyle variables, measures of atherosclerosis damage to the arteries were collected. All measures were collected at baseline and at regular intervals throughout the 2-year trial. Our aims are to use these data to evaluate the relationships between active smoking, exposure to ETS, and these measures of atherosclerosis in NIDDM subjects. We will use the extensive battery of laboratory, clinical, and lifestyle risk factors collected in this study to evaluate how much tobacco exposures (both active and passive) contribute to the degree and progression of atherosclerosis in NIDDM subjects.

This is a clinical investigation that will examine potential mechanisms by which tobacco use in NIDDM subjects contributes to progression of atherosclerosis and increases cardiovascular risk.

The cardiovascular costs of diabetes are immense. NIDDM is a major public health problem in the U.S, particularly among the Hispanic population. Given that the incidence and prevalence of diabetes is increasing in the U.S. and other developed countries, the public health burden of diabetes and smoking-related diabetic complications, is substantial and will continue to grow. This work will quantify the relationship between active smoking, ETS and extent and progression of various measures of atherosclerotic damage to the arteries of persons with diabetes. Atherosclerotic damage to the arteries is a major problem in diabetes, even in the absence of smoking. However, this work will ultimately quantify the degree to which atherosclerosis complications associated with smoking in diabetes can be reduced through modification of active smoking and ETS exposures.

Role of active smoking in subclinical atherosclerosis in type 2 diabetics.
Periodical: TRDRP Annual Report to the State of California Legislature Index Medicus:
Authors: Mack W ABS
Yr: 2001 Vol: Nbr: Abs: Pg: