Diabetes and mortality risk in patients undergoing coronary angiography: The KARDIO study
Jari A Laukkanen1,2, Setor K Kunutsor3, Jaakko Immonen2
1Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
Insights
Diabetes increases mortality risk in patients undergoing coronary angiography, even with severe coronary artery disease (CAD). This risk is independent of other factors but may be influenced by family history and smoking status.
Area of Science:
- Cardiology
- Diabetology
- Clinical Research
Background:
- Diabetes mellitus is a known risk factor for cardiovascular disease and mortality.
- The impact of diabetes on mortality in patients with extensive or diffuse coronary artery disease (CAD) remains debated.
- Understanding this relationship is crucial for patient risk stratification and management.
Purpose of the Study:
- To investigate the association between diabetes and all-cause mortality in patients undergoing coronary angiography.
- To determine if this association persists independently of CAD severity and other cardiovascular risk factors.
- To explore potential modifying effects of clinical characteristics on the diabetes-mortality link.
Main Methods:
- Utilized the KARDIO registry, a real-world clinical database of 79,738 patients.
- Analyzed demographics, comorbidities (including diabetes), risk factors, and coronary angiography data.
- Estimated hazard ratios (HRs) for all-cause mortality associated with diabetes, adjusting for multiple variables.
Main Results:
- Diabetes was associated with a 44% increased mortality risk (HR 1.44; 95% CI 1.38-1.50) after adjustment for confounders.
- This increased risk remained significant even after further adjustment for the degree of coronary artery disease (HR 1.43; 95% CI 1.36-1.49).
- The association was stronger in patients with a family history of CAD and in former smokers.
Conclusions:
- Diabetes independently increases mortality risk in patients undergoing coronary angiography.
- The severity of coronary artery disease does not negate the heightened mortality risk associated with diabetes.
- Family history of CAD and smoking status may modify the mortality risk in diabetic patients.
Background:
Diabetes is an established risk factor for adverse cardiovascular outcomes including mortality, but the relationship between diabetes and mortality risk in the presence of the extensive or diffuse form of coronary artery disease (CAD) is controversial.
Aims:
We evaluated the association between diabetes and mortality risk in patients who underwent coronary angiography using a real-life clinical database.
Methods:
We utilized the KARDIO registry, which comprised data on demographics, prevalent diseases, including diabetes status, cardiovascular risk factors, coronary angiographies, and other interventions in 79,738 patients. Hazard ratios (HRs) (95% confidence intervals [CIs]) for the association between prevalent diabetes and all-cause mortality were estimated.
Results:
During a median follow-up of 5.5 years, 11,896 all-cause deaths occurred. In analyses adjusted for age, smoking status, hypertension, family history of CAD, dyslipidaemia, urgency of intervention, body mass index, sex, and sex-age interaction, the HR (95% CI) for mortality comparing diabetes with no diabetes was 1.44 (1.38, 1.50). Following additional adjustment for the degree of CAD (1-3 vessels disease) as confirmed by angiography, the HR (95% CI) for mortality remained similar 1.43 (1.36, 1.49). The association did not vary significantly across several relevant clinical characteristics except for a stronger association in those with a family history of CAD than those without (p = 0.034) and former smokers than nonsmokers (p = 0.046).
Conclusion:
In patients undergoing coronary angiography, diabetes is associated with an increased mortality risk, independent of several risk factors including the degree of CAD. The association may be modified by family history of CAD and smoking status.
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