Left-Sided Degenerative Valvular Heart Disease in Type 1 and Type 2 Diabetes

Abstract

Background: The role of diabetes in the development of valvular heart disease and particularly the relation with risk factor control, has not been extensively studied. Methods: We included 715,143 patients with diabetes registered in the Swedish National Diabetes Register and compared them with 2,732,333 matched controls randomly selected from the general population. Trends were analyzed with incidence rates and Cox regression, which was also used to assess diabetes as a risk factor compared to controls, and, second, separately in patients with diabetes according to the presence of five risk factors. Results: Incidence for valvular outcomes is increasing among patients with diabetes and the general population. In type 2 diabetes, systolic blood pressure, body mass index and renal function was associated with valvular lesions. Hazard ratios for patients with type 2 diabetes who had nearly all risk factors within target rages, compared with controls, were as follows: aortic stenosis 1.34 (95% CI, 1.31 to 1.38), aortic regurgitation 0.67 (95% CI, 0.64 to 0.70), mitral stenosis 1.95 (95% CI, 1.76 to 2.20), and for mitral regurgitation 0.82 (95% CI, 0.79 to 0.85). Hazard ratios for patients with type 1 diabetes and nearly optimal risk factor control, were as follows: aortic stenosis 2.01 (95% CI, 1.58 to 2.56), aortic regurgitation 0.63 (95% CI, 0.43 to 0.94) and mitral stenosis 3.47 (95% CI, 1.37 to 8.84). Excess risk in patients with type 2 diabetes for stenotic lesions showed hazard ratio for aortic stenosis 1.62 (95% CI, 1.59 to 1.65), mitral stenosis 2.28 (95% CI, 2.08 to 2.50), type 1 diabetes showed 2.59 (95% CI, 2.21 to 3.05) and 11.43 (95% CI, 6.18 to 21.15), respectively. Risk for aortic- and mitral regurgitation was lower in type 2 diabetes; 0.81 (95% CI, 0.78 to 0.84) and 0.95 (95% CI, 0.92 to 0.98), respectively. Conclusions: Individuals with type 1 and 2 diabetes have greater risk for stenotic lesions, whereas risk for valvular regurgitation was lower in type 2 diabetes. Patients with well-controlled cardiovascular risk factors continued to display higher risk for valvular stenosis, without a clear stepwise decrease in risk between various degrees of risk factor control.

Prevalence and impact of diabetes in patients with valvular heart disease

“…A previous study conducted in Sweden found that patients with type 2 diabetes had a significantly lower risk for the occurrence of AR and MR, compared with general population. 13 In the present analysis, we found that diabetes was associated with a lower risk of severe left-sided regurgitant valvular diseases, which also supported the notion that the presence of diabetes impeded the development of valvular regurgitation to some extent. One possible mechanism for the lower risk of severe MR in diabetic patients is mitral annular calcification (MAC).…”

“… 9 , 10 , 11 , 12 However, the impact of diabetes on the occurrence of different types of VHD seems not to be consistently promoting, given that a recent study including more than 710,000 diabetic patients found that those with type 2 diabetes displayed a significantly lower risk of aortic regurgitation (AR) and mitral regurgitation (MR). 13 Currently, the precise nature and relationship between diabetes and the development of different types of severe valvular diseases still remain unknown. Besides, there are scarce data regarding the association of diabetes with outcomes in various VHD.…”

Twenty Years of Cardiovascular Complications and Risk Factors in Patients With Type 2 Diabetes: A Nationwide Swedish Cohort Study

“…An example of the Cox regression modeling strategy, estimating the optimal levels for HbA1c, is presented in the Supplemental Material. 10,11 Multifactorial Risk Factor Within Target…”

Non-coronary peripheral arterial complications in people with type 2 diabetes: a Swedish retrospective cohort study

“…The study uses data from the Swedish National Diabetes Registry (NDR) and includes information on risk factors, complications of diabetes and medications for patients 18 years of age or older. 3 , 15 , 16 , 17 The NDR includes >90% of all individuals in Sweden with type 2 diabetes mellitus and the diagnosis was defined using an epidemiological definition that treatment with diet with or without the use of oral antihyperglycemic agents or treatment with insulin with or without the use of oral antihyperglycemic agents; the latter category only applied to patients who were 40 years of age or older at the time of diabetes diagnosis. Furthermore, for those with missing information on diabetes classification according to the epidemiological definition, diabetes status was determined through a clinical assessment conducted by physicians and were identified as people with type 2 diabetes mellitus.…”