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Range of Risk Factor Levels: Control, Mortality, and Cardiovascular Outcomes in Type 1 Diabetes Mellitus
Aidin Rawshani1, Araz Rawshani2, Stefan Franzén2
1From Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren); Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.); Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK (N.S.). aidin.rawshani@gu.se.
Insights
Individuals with type 1 diabetes mellitus (T1DM) face higher cardiovascular risks. Even when treatment goals are met, T1DM patients have increased mortality and adverse outcomes compared to the general population.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Type 1 diabetes mellitus (T1DM) is associated with a significantly elevated risk of cardiovascular complications.
- The residual risk of mortality and cardiovascular events in T1DM patients who achieve treatment goals remains unclear compared to the general population.
Purpose of the Study:
- To investigate the association between achieving cardiovascular treatment goals and the residual risk of mortality and major adverse cardiovascular outcomes in T1DM patients compared to individuals without diabetes.
Main Methods:
- A cohort study included 33,333 T1DM patients from the Swedish National Diabetes Register (1998-2014), matched with 166,529 controls.
- Patients were categorized by the number of uncontrolled risk factors: glycated hemoglobin, blood pressure, albuminuria, smoking, and LDL cholesterol.
- The study examined risks for all-cause mortality, myocardial infarction, heart failure hospitalization, and stroke in relation to risk factor control.
Main Results:
- A stepwise increase in risk for all outcomes was observed with each additional uncontrolled risk factor.
- Even when all risk factors were controlled, T1DM patients had numerically higher risks for all-cause mortality, myocardial infarction, heart failure, and stroke compared to controls.
- Statistically significant higher risks for acute myocardial infarction and heart failure hospitalization were noted in T1DM patients even with optimal risk factor control.
Conclusions:
- A strong association exists between the number of uncontrolled cardiovascular risk factors and adverse outcomes in T1DM.
- Despite achieving treatment targets, T1DM patients exhibit a higher residual risk for major adverse cardiovascular outcomes, particularly myocardial infarction and heart failure.
Background:
Individuals with type 1 diabetes mellitus (T1DM) have a 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 those with T1DM compared with the general population.
Methods:
We included all patients ≥18 years of age with T1DM who were registered in the Swedish National Diabetes Register from January 1, 1998, through December 31, 2014, a total of 33 333 patients, each matched for age and sex with 5 controls without diabetes mellitus randomly selected from the population. Patients with T1DM were categorized according to number of risk factors not at target: glycohemoglobin, blood pressure, albuminuria, smoking, and low-density lipoprotein cholesterol. Risk of all-cause mortality, acute myocardial infarction, heart failure hospitalization, 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 mellitus and 4141 of 166 529 controls died. Risk for all outcomes increased stepwise for each additional risk factor not at target. Adjusted hazard ratios for patients achieving all risk factor targets compared with controls were 1.31 (95% confidence interval [CI], 0.93-1.85) for all-cause mortality, 1.82 (95% CI, 1.15-2.88) for acute myocardial infarction, 1.97 (95% CI, 1.04-3.73) for heart failure hospitalization, and 1.17 (95% CI, 0.51-2.68) for stroke. The hazard ratio 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 acute myocardial infarction, 15.09 (95% CI, 9.87-23.09) for heart failure hospitalization, and 12.02 (95% CI, 7.66-18.85) for stroke.
Conclusions:
A steep-graded association exists between decreasing number of cardiovascular risk factors at target and major adverse cardiovascular outcomes among patients with T1DM. However, risks for all outcomes were numerically higher for patients with T1DM compared with controls, even when all risk factors were at target, with risk for acute myocardial infarction and heart failure hospitalization statistically significantly higher.
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