Mortality and cardiovascular disease in type 1 and type 2 diabetes

Aidin Rawshani, Araz Rawshani, Stefan Franzén, Björn Eliasson, Ann Marie Svensson, Mervete Miftaraj, Darren K McGuire, Naveed Sattar, Annika Rosengren, Soffia Gudbjörnsdottir

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Abstract

BACKGROUND Long-term trends in excess risk of death and cardiovascular outcomes have not been extensively studied in persons with type 1 diabetes or type 2 diabetes. METHODS We included patients registered in the Swedish National Diabetes Register from 1998 through 2012 and followed them through 2014. Trends in deaths and cardiovascular events were estimated with Cox regression and standardized incidence rates. For each patient, controls who were matched for age, sex, and county were randomly selected from the general population. RESULTS Among patients with type 1 diabetes, absolute changes during the study period in the incidence rates of sentinel outcomes per 10,000 person-years were as follows: death from any cause, -31.4 (95% confidence interval [CI], -56.1 to -6.7); death from cardiovascular disease, -26.0 (95% CI, -42.6 to -9.4); death from coronary heart disease, -21.7 (95% CI, -37.1 to -6.4); and hospitalization for cardiovascular disease, -45.7 (95% CI, -71.4 to -20.1). Absolute changes per 10,000 person-years among patients with type 2 diabetes were as follows: death from any cause, -69.6 (95% CI, -95.9 to -43.2); death from cardiovascular disease, -110.0 (95% CI, -128.9 to -91.1); death from coronary heart disease, -91.9 (95% CI, -108.9 to -75.0); and hospitalization for cardiovascular disease, -203.6 (95% CI, -230.9 to -176.3). Patients with type 1 diabetes had roughly 40% greater reduction in cardiovascular outcomes than controls, and patients with type 2 diabetes had roughly 20% greater reduction than controls. Reductions in fatal outcomes were similar in patients with type 1 diabetes and controls, whereas patients with type 2 diabetes had smaller reductions in fatal outcomes than controls. CONCLUSIONS In Sweden from 1998 through 2014, mortality and the incidence of cardiovascular outcomes declined substantially among persons with diabetes, although fatal outcomes declined less among those with type 2 diabetes than among controls.

Original languageEnglish (US)
Pages (from-to)1407-1418
Number of pages12
JournalNew England Journal of Medicine
Volume376
Issue number15
DOIs
StatePublished - Apr 13 2017

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Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Cardiovascular Diseases
Confidence Intervals
Mortality
Fatal Outcome
Coronary Disease
Cause of Death
Incidence
Hospitalization
Sweden
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Rawshani, A., Rawshani, A., Franzén, S., Eliasson, B., Svensson, A. M., Miftaraj, M., ... Gudbjörnsdottir, S. (2017). Mortality and cardiovascular disease in type 1 and type 2 diabetes. New England Journal of Medicine, 376(15), 1407-1418. https://doi.org/10.1056/NEJMoa1608664

Mortality and cardiovascular disease in type 1 and type 2 diabetes. / Rawshani, Aidin; Rawshani, Araz; Franzén, Stefan; Eliasson, Björn; Svensson, Ann Marie; Miftaraj, Mervete; McGuire, Darren K; Sattar, Naveed; Rosengren, Annika; Gudbjörnsdottir, Soffia.

In: New England Journal of Medicine, Vol. 376, No. 15, 13.04.2017, p. 1407-1418.

Research output: Contribution to journalArticle

Rawshani, A, Rawshani, A, Franzén, S, Eliasson, B, Svensson, AM, Miftaraj, M, McGuire, DK, Sattar, N, Rosengren, A & Gudbjörnsdottir, S 2017, 'Mortality and cardiovascular disease in type 1 and type 2 diabetes', New England Journal of Medicine, vol. 376, no. 15, pp. 1407-1418. https://doi.org/10.1056/NEJMoa1608664
Rawshani A, Rawshani A, Franzén S, Eliasson B, Svensson AM, Miftaraj M et al. Mortality and cardiovascular disease in type 1 and type 2 diabetes. New England Journal of Medicine. 2017 Apr 13;376(15):1407-1418. https://doi.org/10.1056/NEJMoa1608664
Rawshani, Aidin ; Rawshani, Araz ; Franzén, Stefan ; Eliasson, Björn ; Svensson, Ann Marie ; Miftaraj, Mervete ; McGuire, Darren K ; Sattar, Naveed ; Rosengren, Annika ; Gudbjörnsdottir, Soffia. / Mortality and cardiovascular disease in type 1 and type 2 diabetes. In: New England Journal of Medicine. 2017 ; Vol. 376, No. 15. pp. 1407-1418.
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AU - Miftaraj, Mervete

AU - McGuire, Darren K

AU - Sattar, Naveed

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N2 - BACKGROUND Long-term trends in excess risk of death and cardiovascular outcomes have not been extensively studied in persons with type 1 diabetes or type 2 diabetes. METHODS We included patients registered in the Swedish National Diabetes Register from 1998 through 2012 and followed them through 2014. Trends in deaths and cardiovascular events were estimated with Cox regression and standardized incidence rates. For each patient, controls who were matched for age, sex, and county were randomly selected from the general population. RESULTS Among patients with type 1 diabetes, absolute changes during the study period in the incidence rates of sentinel outcomes per 10,000 person-years were as follows: death from any cause, -31.4 (95% confidence interval [CI], -56.1 to -6.7); death from cardiovascular disease, -26.0 (95% CI, -42.6 to -9.4); death from coronary heart disease, -21.7 (95% CI, -37.1 to -6.4); and hospitalization for cardiovascular disease, -45.7 (95% CI, -71.4 to -20.1). Absolute changes per 10,000 person-years among patients with type 2 diabetes were as follows: death from any cause, -69.6 (95% CI, -95.9 to -43.2); death from cardiovascular disease, -110.0 (95% CI, -128.9 to -91.1); death from coronary heart disease, -91.9 (95% CI, -108.9 to -75.0); and hospitalization for cardiovascular disease, -203.6 (95% CI, -230.9 to -176.3). Patients with type 1 diabetes had roughly 40% greater reduction in cardiovascular outcomes than controls, and patients with type 2 diabetes had roughly 20% greater reduction than controls. Reductions in fatal outcomes were similar in patients with type 1 diabetes and controls, whereas patients with type 2 diabetes had smaller reductions in fatal outcomes than controls. CONCLUSIONS In Sweden from 1998 through 2014, mortality and the incidence of cardiovascular outcomes declined substantially among persons with diabetes, although fatal outcomes declined less among those with type 2 diabetes than among controls.

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