Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes

Abstract

BACKGROUNDLong-term trends in excess risk of death and cardiovascular outcomes have not been extensively studied in persons with type 1 diabetes or type 2 diabetes. METHODSWe included patients registered in the Swedish National Diabetes Register from 1998 through 2012 and followed them through 2014. Trends in deaths and cardiovascular events were estimated with Cox regression and standardized incidence rates. For each patient, controls who were matched for age, sex, and county were randomly selected from the general population. RESULTSAmong patients with type 1 diabetes, absolute changes during the study period in the incidence rates of sentinel outcomes per 10,000 person-years were as follows: death from any cause, −31.4 (95% confidence interval [CI], −56.1 to −6.7); death from cardiovascular disease, −26.0 (95% CI, −42.6 to −9.4); death from coronary heart disease, −21.7 (95% CI, −37.1 to −6.4); and hospitalization for cardiovascular disease, −45.7 (95% CI, −71.4 to −20.1). Absolute changes per 10,000 person-years among patients with type 2 diabetes were as follows: death from any cause, −69.6 (95% CI, −95.9 to −43.2); death from cardiovascular disease, −110.0 (95% CI, −128.9 to −91.1); death from coronary heart disease, −91.9 (95% CI, −108.9 to −75.0); and hospitalization for cardiovascular disease, −203.6 (95% CI, −230.9 to −176.3). Patients with type 1 diabetes had roughly 40% greater reduction in cardiovascular outcomes than controls, and patients with type 2 diabetes had roughly 20% greater reduction than controls. Reductions in fatal outcomes were similar in patients with type 1 diabetes and controls, whereas patients with type 2 diabetes had smaller reductions in fatal outcomes than controls. CONCLUSIONSIn Sweden from 1998 through 2014, mortality and the incidence of cardiovascular outcomes declined substantially among persons with diabetes, although fatal outcomes declined less among those with type 2 diabetes than among controls. (Funded by the Swedish Association of Local Authorities and Regions and others.) a bs tr ac t

Cardiovascular Risk in Type 1 Diabetes Mellitus

“…A recent long-term follow-up of patients registered in the Swedish National Diabetes Register found no effect from improved management of established risk factors on hospitalizations for heart failure in patients with T1DM, whereas patients with T2DM had a greater event-rate reduction than their matched controls, suggesting that some processes contributing to heart failure risk are not addressed by current clinical care for patients with T1DM [ 9 ].…”

“…Improved management of traditional cardiovascular risk factors has led to remarkable improvements in survival, with a 29% reduction in the relative risk of death over a 10-year period [ 9 ], such that the overall relative risk for CVD is now 2.3 for men and 3.0 for women [ 10 ]. This relative risk was previously reported as being 3.6 in men and 7.7 in women [ 4 ].…”

Association of haptoglobin phenotype with incident acute myocardial infarction in Chinese patients with type 2 diabetes

“…Cardiovascular disease (CVD) is a major complication of type 2 diabetes (T2D) and the leading cause of death [1, 2]. The incidence of acute myocardial infarction (AMI) is higher in T2D and [3] survival after incident event is remarkably low [4, 5].…”

Postprandial Glucose Spikes, an Important Contributor to Cardiovascular Disease in Diabetes?

“…Although the pathophysiological mechanisms through which individuals develop type 1 and type 2 diabetes are different, both conditions are characterized by elevated blood glucose levels and share a similar elevated risk of cardiovascular mortality (1). Despite the fact that benefits from intensive glucose-lowering treatment were obvious in reducing microvascular complications in initial trials such as the Diabetes Control and Complications Trial (DCCT) (type 1 diabetes), the Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trials (type 2 diabetes) showed no obvious benefit from glucose lowering treatment in the short term (2).…”