Age at diagnosis of type 2 diabetes mellitus and associations with cardiovascular and mortality risks findings from the Swedish National Diabetes Registry

Sattar, N. , Rawshani, A., Franzén, S., Rawshani, A., Svensson, A.-M., Rosengren, A., McGuire, D. K., Eliasson, B. and Gudbjörnsdottir, S. (2019) Age at diagnosis of type 2 diabetes mellitus and associations with cardiovascular and mortality risks findings from the Swedish National Diabetes Registry. Circulation, 139(19), pp. 2228-2237. (doi:10.1161/CIRCULATIONAHA.118.037885) (PMID:30955347)

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Abstract

Background: Risk of cardiovascular disease (CVD) and mortality for patients with versus without type 2 diabetes mellitus (T2DM) appears to vary by the age at T2DM diagnosis, but few population studies have analyzed mortality and CVD outcomes associations across the full age range. Methods: With use of the Swedish National Diabetes Registry, everyone with T2DM registered in the Registry between 1998 and 2012 was included. Controls were randomly selected from the general population matched for age, sex, and county. The analysis cohort comprised 318083 patients with T2DM matched with just <1.6 million controls. Participants were followed from 1998 to 2013 for CVD outcomes and to 2014 for mortality. Outcomes of interest were total mortality, cardiovascular mortality, noncardiovascular mortality, coronary heart disease, acute myocardial infarction, stroke, heart failure, and atrial fibrillation. We also examined life expectancy by age at diagnosis. We conducted the primary analyses using Cox proportional hazards models in those with no previous CVD and repeated the work in the entire cohort. Results: Over a median follow-up period of 5.63 years, patients with T2DM diagnosed at ≤40 years had the highest excess risk for most outcomes relative to controls with adjusted hazard ratio (95% CI) of 2.05 (1.81–2.33) for total mortality, 2.72 (2.13–3.48) for cardiovascularrelated mortality, 1.95 (1.68–2.25) for noncardiovascular mortality, 4.77 (3.86–5.89) for heart failure, and 4.33 (3.82–4.91) for coronary heart disease. All risks attenuated progressively with each increasing decade at diagnostic age; by the time T2DM was diagnosed at >80 years, the adjusted hazard ratios for CVD and non-CVD mortality were <1, with excess risks for other CVD outcomes substantially attenuated. Moreover, survival in those diagnosed beyond 80 was the same as controls, whereas it was more than a decade less when T2DM was diagnosed in adolescence. Finally, hazard ratios for most outcomes were numerically greater in younger women with T2DM. Conclusions: Age at diagnosis of T2DM is prognostically important for survival and cardiovascular risks, with implications for determining the timing and intensity of risk factor interventions for clinical decision making and for guideline-directed care. These observations amplify support for preventing/delaying T2DM onset in younger individuals.

Item Type:Articles
Additional Information:The Swedish Association of Local Authorities Regions provided financial support for this study. We also received funding from the Swedish Heart and Lung Foundation (2017-0839) and the Swedish Research Council (2013–5187, SIMSAM).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Sattar, Professor Naveed
Authors: Sattar, N., Rawshani, A., Franzén, S., Rawshani, A., Svensson, A.-M., Rosengren, A., McGuire, D. K., Eliasson, B., and Gudbjörnsdottir, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Circulation
Publisher:American Heart Association
ISSN:0009-7322
ISSN (Online):1524-4539
Published Online:08 April 2019
Copyright Holders:Copyright © 2019 American Heart Association, Inc.
First Published:First published in Circulation 139(19): 2228-2237
Publisher Policy:Reproduced in accordance with the publisher copyright policy
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