Early life exposure to 1959-1961 Chinese famine exacerbates association between diabetes and cardiovascular disease

Background: We aimed to assess whether early life exposure to the Chinese famine (1959-1961) modifies the association between type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) in adulthood. Methods: Data from 4247 adults born between 1954 and 1964 from the 2011 and 2015 China Health and Retirement Longitudinal Study (CHARLS) were analyzed. CVD in 2011 and 2015 was based on self-reported doctor's diagnosis of cardiac events (heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems) and stroke. Diabetes in 2011 was defined by fasting blood glucose, HbA1C, or known diabetes. Results: Diabetes in 2011 was cross-sectionally associated with an increase of CVD risk in 2011 (OR 1.91, 95%CI 1.53-2.40, P < 0.001) after adjusting for age and gender. Famine exposure changed the association between diabetes and CVD in areas severely affected by famine. The odds ratios (OR) of diabetes in 2011 for CVD in 2015 were 1.24 (95%CI 0.73-2.10), 1.27 (95%CI 0.72-2.24), 2.25 (95%CI 1.29-3.91), 4.31 (95%CI 2.07-8.97) and 1.72 (95%CI 0.84-3.51) among adults in late childhood-, mid-childhood-, early childhood-, fetal-, and nonexposed cohorts in severe famine areas, respectively. Conclusion: T2DM is associated with the risk of CVD among Chinese adults. Fetal and early childhood exposure to the Chinese famine exacerbated the associated risk.