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High mortality from unidentified CVD in IDDM: time to start screening?
E I Portuese1, L Kuller, D Becker
1University of Pittsburgh, Department of Epidemiology, Graduate School of Public Health, Pittsburgh, PA, USA.
Diabetes Research and Clinical Practice
|December 1, 1995
Summary
Mortality in insulin-dependent diabetes (IDDM) is high, with cardiovascular disease (CVD) being a major cause of death. Renal disease and factors like smoking, triglycerides, and platelet count independently predict mortality in IDDM patients.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Insulin-dependent diabetes (IDDM) is associated with significantly increased mortality rates compared to the general population.
- The interplay between renal disease and cardiovascular disease (CVD) risk in IDDM patients remains incompletely understood.
Purpose of the Study:
- To investigate risk factors for mortality in IDDM patients.
- To specifically examine the relationship between renal disease and CVD in the context of IDDM mortality.
Main Methods:
- A nested case-control study was conducted within the prospective Epidemiology of Diabetes Complications study.
- 37 deaths among 658 IDDM individuals were analyzed over a 4-year follow-up period, matched for sex and diabetes duration.
Main Results:
- Coronary heart disease (CHD) accounted for 59% of deaths; 41% of CVD deaths lacked prior CHD evidence but often showed lower extremity arterial disease.
- A strong association between renal disease and coronary artery disease death was observed (81%).
- Independent predictors of mortality included smoking, triglycerides, and platelet count; LDL cholesterol predicted CVD mortality.
Conclusions:
- Intensified screening for CVD and aggressive management of risk factors are crucial for reducing IDDM mortality.
- Preventing or delaying renal disease may also contribute to improved survival in IDDM patients.