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Relative Prognostic Importance and Optimal Levels of Risk Factors for Mortality and Cardiovascular Outcomes in Type 1 Diabetes Mellitus
Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden;Swedish Natl Diabet Register, Ctr Registers Reg, Gothenburg, Sweden.
Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden;Swedish Natl Diabet Register, Ctr Registers Reg, Gothenburg, Sweden.
Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland.
Swedish Natl Diabet Register, Ctr Registers Reg, Gothenburg, Sweden;Univ Gothenburg, Sahlgrenska Acad, Hlth Metr Unit, Gothenburg, Sweden.
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2019 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 139, no 16, p. 1900-1912Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The strength of association and optimal levels for risk factors related to excess risk of death and cardiovascular outcomes in type 1 diabetes mellitus have been sparsely studied. METHODS: In a national observational cohort study from the Swedish National Diabetes Register from 1998 to 2014, we assessed relative prognostic importance of 17 risk factors for death and cardiovascular outcomes in individuals with type 1 diabetes mellitus. We used Cox regression and machine learning analyses. In addition, we examined optimal cut point levels for glycohemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol. Patients with type 1 diabetes mellitus were followed up until death or study end on December 31, 2013. The primary outcomes were death resulting from all causes, fatal/nonfatal acute myocardial infarction, fatal/nonfatal stroke, and hospitalization for heart failure. RESULTS: Of 32 611 patients with type 1 diabetes mellitus, 1809 (5.5%) died during follow-up over 10.4 years. The strongest predictors for death and cardiovascular outcomes were glycohemoglobin, albuminuria, duration of diabetes mellitus, systolic blood pressure, and low-density lipoprotein cholesterol. Glycohemoglobin displayed approximate to 2% higher risk for each 1-mmol/mol increase (equating to approximate to 22% per 1% glycohemoglobin difference), whereas low-density lipoprotein cholesterol was associated with 35% to 50% greater risk for each 1-mmol/L increase. Microalbuminuria or macroalbuminuria was associated with 2 to 4 times greater risk for cardiovascular complications and death. Glycohemoglobin <53 mmol/mol (7.0%), systolic blood pressure <140 mm Hg, and low-density lipoprotein cholesterol <2.5 mmol/L were associated with significantly lower risk for outcomes observed. CONCLUSIONS: Glycohemoglobin, albuminuria, duration of diabetes mellitus, systolic blood pressure, and low-density lipoprotein cholesterol appear to be the most important predictors for mortality and cardiovascular outcomes in patients with type 1 diabetes mellitus. Lower levels for glycohemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol than contemporary guideline target levels appear to be associated with significantly lower risk for outcomes.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019. Vol. 139, no 16, p. 1900-1912
Keywords [en]
cardiovascular disease, cerebrovascular disorders, diabetes mellitus, type 1, glycated hemoglobin A, heart failure, mortality, risk factors
National Category
Endocrinology and Diabetes Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-387557DOI: 10.1161/CIRCULATIONAHA.118.037454ISI: 000469321500007PubMedID: 30798638OAI: oai:DiVA.org:uu-387557DiVA, id: diva2:1330305
Funder
Swedish Research Council, 2013-5187Swedish Heart Lung Foundation, 2017-0839Swedish Association of Local Authorities and RegionsAvailable from: 2019-06-25 Created: 2019-06-25 Last updated: 2019-06-25Bibliographically approved

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