Range of risk factor levels: control, mortality and cardiovascular outcomes in type 1 diabetes mellitus

Rawshani, A., Rawshani, A., Franzén, S., Eliasson, B., Svensson, A.-M., Miftaraj, M., McGuire, D. K., Sattar, N. , Rosengren, A. and Gudbjörnsdottir, S. (2017) Range of risk factor levels: control, mortality and cardiovascular outcomes in type 1 diabetes mellitus. Circulation, 135(16), pp. 1522-1531. (doi: 10.1161/CIRCULATIONAHA.116.025961) (PMID:28416524) (PMCID:PMC5400410)

Abstract

Background—Individuals with type 1 diabetes have high risk of cardiovascular complications, but it is unknown to what extent fulfilling all cardiovascular treatment goals is associated with residual risk of mortality and cardiovascular outcomes in type 1 diabetes compared with the general population. Methods—We included all patients with type 1 diabetes aged >=18 years registered in the Swedish National Diabetes Register from January 1, 1998 - December 31, 2014, in all 33,333 patients, each matched for age and sex with 5 controls without diabetes randomly selected from the population. Patients with type 1 diabetes were categorized according to number of risk factors not at target: glycated hemoglobin, blood pressure, albuminuria, smoking and LDL cholesterol. Risk of all-cause mortality, acute myocardial infarction (AMI), heart failure hospitalization (HF) and stroke was examined in relation to the number of risk factors at target.Results—The mean follow-up was 10.4 years in the diabetes group. Overall, 2074 of 33,333 patients with diabetes and 4141 of 166,529 controls died. Risk for all outcomes increased stepwise for each additional risk factor not at target. Adjusted hazard ratios (HR) for patients achieving all risk factor targets compared with controls were 1.31 (95% CI 0.93-1.85) for all-cause mortality; 1.82 (95% CI 1.15-2.88) for AMI; 1.97 (95% CI 1.04-3.73) for HF; and 1.17 (95% CI 0.51-2.68) for stroke. HR for patients versus controls with none of the risk factors meeting target was 7.33 (95% CI 5.08-10.57) for all-cause mortality; 12.34 (95% CI 7.91-19.48) for AMI: 15.09 (95% CI 9.87-23.09) for HF; and 12.02 (95% CI 7.66-18.85) for stroke.Conclusions—A steep graded association exists between decreasing number of CV risk factors at target and major adverse CV outcomes among patients with T1DM. However, risks for all outcomes were numerically higher for T1DM patients compared with controls, even when all risk factors were at target, with risk for AMI and HF statistically significantly so.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Sattar, Professor Naveed
• Authors: Rawshani, A., Rawshani, A., Franzén, S., Eliasson, B., Svensson, A.-M., Miftaraj, M., McGuire, D. K., Sattar, N., Rosengren, A., and Gudbjörnsdottir, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Circulation
• Publisher: American Heart Association
• ISSN: 0009-7322
• ISSN (Online): 1524-4539
• Published Online: 22 February 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in Circulation 135(16):1522-1531
• Publisher Policy: Reproduced under a Creative Commons License