OBJECTIVE -To estimate the absolute and relative risk of cardiovascular disease (CVD) in patients with type 1 diabetes in the U.K.RESEARCH DESIGN AND METHODS -Subjects with type 1 diabetes (n ϭ 7,479) and five age-and sex-matched subjects without diabetes (n ϭ 38,116) and free of CVD at baseline were selected from the General Practice Research Database (GPRD), a large primary care database representative of the U.K. population. Incident major CVD events, comprising myocardial infarction, acute coronary heart disease death, coronary revascularizations, or stroke, were captured for the period 1992-1999.RESULTS -The hazard ratio (HR) for major CVD was 3.6 (95% CI 2.9 -4.5) in type 1 diabetic men compared with those without diabetes and 7.7 (5.5-10.7) in women. Increased HRs were found for acute coronary events (3.0 and 7.6 in type 1 diabetic men and women, respectively, versus nondiabetic subjects), coronary revascularizations (5.0 in men, 16.8 in women), and for stroke (3.7 in men, 4.8 in women). Type 1 diabetic men aged 45-55 years had an absolute CVD risk similar to that of men in the general population 10 -15 years older, with an even greater difference in women.CONCLUSIONS -Despite advances in care, these data show that absolute and relative risks of CVD remain extremely high in patients with type 1 diabetes. Women with type 1 diabetes continue to experience greater relative risks of CVD than men compared with those without diabetes. Diabetes Care 29:798 -804, 2006

General practice computers have been widely used in the United Kingdom for the last 10 years and there are over 30 different systems currently available. The commercially available databases are based on two of the most widely used systems--VAMP Medical and Meditel. These databases provide both longitudinal and cross-sectional data on between 1.8 and 4 million patients. Despite their availability only limited use has been made of them for epidemiological and health service research purposes. They are a unique source of population-based information and deserve to be better recognized. The advantages of general practice databases include the fact that they are population based with excellent prescribing data linked to diagnosis, age and gender. The problems are that their primary purpose is patient care and the database population is constantly changing, as well as the usual problems of bias and confounding that occur in any observational studies. The barriers to the use of general practice databases include the cost of access, the size of the databases and that they are not structured in a way that easily allows analysis. Proper utilization of these databases requires powerful computers, staff proficient in writing computer programs to facilitate analysis and epidemiologists skilled in their use. If these structural problems are overcome then the databases are an invaluable source of data for epidemiological studies.

Aims  Under‐reporting of diabetes on death certificates contributes to the unreliable estimates of mortality as a result of diabetes. The influence of obesity on mortality in Type 2 diabetes is not well documented. We aimed to study mortality from diabetes and the influence of obesity on mortality in Type 2 diabetes in a large cohort selected from the General Practice Research Database (GPRD). Methods  A cohort of 44 230 patients aged 35–89 years in 1992 with Type 2 diabetes was identified. A comparison group matched by year of birth and sex with no record of diabetes at any time was identified (219 797). Hazards ratios (HRs) for all‐cause mortality during the period January 1992 to October 1999 were calculated using the Cox Proportional Hazards Model. The effects of body mass index (BMI), smoking and duration of diabetes on all‐cause mortality amongst people with diabetes was assessed (n = 28 725). Results  The HR for all‐cause mortality in Type 2 diabetes compared with no diabetes was 1.93 (95% CI 1.89–1.97), in men 1.77 (1.72–1.83) and in women 2.13 (2.06–2.20). The HR decreased with increasing age. In the multivariate analysis in diabetes only, the HR for all‐cause mortality amongst smokers was 1.50 (1.41–1.61). Using BMI 20–24 kg/m2 as the reference range, for those with a BMI 35–54 kg/m2 the HR was 1.43 (1.28–1.59) and for those with a BMI 15–19 kg/m2 the HR was 1.38 (1.18–1.61). Conclusions  Patients with Type 2 diabetes have almost double the mortality rate compared with those without. The relative risk decreases with age. In people with Type 2 diabetes, obesity and smoking both contribute to the risk of all‐cause mortality, supporting doctrines to stop smoking and lose weight.

Aims The study was conducted to determine whether the method for selecting cases of venous thromboembolism (VTE) from general practice databases signi®cantly affected the ®ndings of an epidemiological study. Methods Cases of VTE were identi®ed from the UK General Practice Research Database (GPRD) by searching for codes for deep vein thrombosis (DVT) and pulmonary embolism (PE). These had to be supported by evidence of anticoagulation and be exposed to a combined oral contraceptive (COC) at the time of the event. Additional information about the event was sought from general practitioners who were requested to complete a questionnaire and to supply anonymised copies of hospital letters and discharge summaries. Results Of the 285 cases identi®ed from the GPRD, additional information was available for 177 VTE events. This information showed that 84% of those events were supported by hospital investigations or a death certi®cate. Using only veri®ed cases, rather than all GPRD identi®ed events, did not alter the results of the epidemiological study.Conclusions The GPRD provides information of suf®ciently high quality to allow valid epidemiological research of VTE events. Excluding cases without a database record of hospital admission would lead to valid events being overlooked, and an under-estimate of the disease incidence.

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