Approved Research

Defining factors that modify the association between diabetes mellitus and cardiovascular disease

Lay summary

Diabetes mellitus (DM) is a condition where blood sugar levels are too high because of reduced action or production of the hormone insulin. Soon, one in ten adults in the UK are expected to have DM. People with DM experience twice the risk of important cardiovascular problems like heart attack, stroke or heart failure, and these problems occur 15 years earlier than in people without diabetes. These risks can be reduced by health lifestyles, medications and other treatments, but even when used optimally, these approaches only modestly reduce the risk of cardiovascular disease in people with DM. We think that this might be because diabetes is often associated with many other health problems that act in conjunction with diabetes to substantially increase the development of cardiovascular disease. UK Biobank provides an excellent opportunity for us to test this premise.

We will test a wide range of 'modifying factors' that might act together with diabetes to increase the risk of cardiovascular disease; broadly, these will include other diseases (e.g. kidney disease), other factors in the environment (e.g. air pollution) and inherited variations in genes (e.g. which can lead to inherited heart diseases). We will use a wide range of UK Biobank data to define people with cardiovascular damage or disease, ranging from mild asymptomatic problems at recruitment, through to those who die as a result of cardiovascular problems. Our experiments will test whether people with diabetes experience a greater risk of cardiovascular problems linked with a 'modifying factor' than people without diabetes. When we identify 'modifying factors', we will aim to understand how these might act together with diabetes to cause cardiovascular problems. We will also look for common features of 'modifying factors' that we identify.

The project will span at least 3 years, and will form part of a doctor in training's PhD project. We hope that our findings will improve the understanding of how diabetes results in accelerated cardiovascular disease, and that this knowledge will eventually lead to more effective preventative therapies. This has to potential to improve the lives of people with diabetes, along with having important implications for healthcare systems and society.