Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes

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

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Abstract

BACKGROUND Patients with diabetes are at higher risk for death and cardiovascular outcomes than the general population. We investigated whether the excess risk of death and cardiovascular events among patients with type 2 diabetes could be reduced or eliminated. METHODS In a cohort study, we included 271,174 patients with type 2 diabetes who were registered in the Swedish National Diabetes Register and matched them with 1,355,870 controls on the basis of age, sex, and county. We assessed patients with diabetes according to age categories and according to the presence of five risk factors (elevated glycated hemoglobin level, elevated low-density lipoprotein cholesterol level, albuminuria, smoking, and elevated blood pressure). Cox regression was used to study the excess risk of outcomes (death, acute myocardial infarction, stroke, and hospitalization for heart failure) associated with smoking and the number of variables outside target ranges. We also examined the relationship between various risk factors and cardiovascular outcomes. RESULTS The median follow-up among all the study participants was 5.7 years, during which 175,345 deaths occurred. Among patients with type 2 diabetes, the excess risk of outcomes decreased stepwise for each risk-factor variable within the target range. Among patients with diabetes who had all five variables within target ranges, the hazard ratio for death from any cause, as compared with controls, was 1.06 (95% confidence interval [CI], 1.00 to 1.12), the hazard ratio for acute myocardial infarction was 0.84 (95% CI, 0.75 to 0.93), and the hazard ratio for stroke was 0.95 (95% CI, 0.84 to 1.07). The risk of hospitalization for heart failure was consistently higher among patients with diabetes than among controls (hazard ratio, 1.45; 95% CI, 1.34 to 1.57). In patients with type 2 diabetes, a glycated hemoglobin level outside the target range was the strongest predictor of stroke and acute myocardial infarction; smoking was the strongest predictor of death. CONCLUSIONS Patients with type 2 diabetes who had five risk-factor variables within the target ranges appeared to have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population.

Original languageEnglish (US)
Pages (from-to)633-644
Number of pages12
JournalNew England Journal of Medicine
Volume379
Issue number7
DOIs
StatePublished - Aug 16 2018

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Type 2 Diabetes Mellitus
Mortality
Stroke
Myocardial Infarction
Confidence Intervals
Smoking
Glycosylated Hemoglobin A
Hospitalization
Heart Failure
Safety Management
Albuminuria
LDL Cholesterol
Population
Cause of Death
Cohort Studies
Blood Pressure

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Rawshani, A., Rawshani, A., Franzén, S., Sattar, N., Eliasson, B., Svensson, A. M., ... Gudbjörnsdottir, S. (2018). Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. New England Journal of Medicine, 379(7), 633-644. https://doi.org/10.1056/NEJMoa1800256

Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. / Rawshani, Aidin; Rawshani, Araz; Franzén, Stefan; Sattar, Naveed; Eliasson, Björn; Svensson, Ann Marie; Zethelius, Björn; Miftaraj, Mervete; McGuire, Darren K; Rosengren, Annika; Gudbjörnsdottir, Soffia.

In: New England Journal of Medicine, Vol. 379, No. 7, 16.08.2018, p. 633-644.

Research output: Contribution to journalArticle

Rawshani, A, Rawshani, A, Franzén, S, Sattar, N, Eliasson, B, Svensson, AM, Zethelius, B, Miftaraj, M, McGuire, DK, Rosengren, A & Gudbjörnsdottir, S 2018, 'Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes', New England Journal of Medicine, vol. 379, no. 7, pp. 633-644. https://doi.org/10.1056/NEJMoa1800256
Rawshani A, Rawshani A, Franzén S, Sattar N, Eliasson B, Svensson AM et al. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. New England Journal of Medicine. 2018 Aug 16;379(7):633-644. https://doi.org/10.1056/NEJMoa1800256
Rawshani, Aidin ; Rawshani, Araz ; Franzén, Stefan ; Sattar, Naveed ; Eliasson, Björn ; Svensson, Ann Marie ; Zethelius, Björn ; Miftaraj, Mervete ; McGuire, Darren K ; Rosengren, Annika ; Gudbjörnsdottir, Soffia. / Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. In: New England Journal of Medicine. 2018 ; Vol. 379, No. 7. pp. 633-644.
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AU - Franzén, Stefan

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AU - Eliasson, Björn

AU - Svensson, Ann Marie

AU - Zethelius, Björn

AU - Miftaraj, Mervete

AU - McGuire, Darren K

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N2 - BACKGROUND Patients with diabetes are at higher risk for death and cardiovascular outcomes than the general population. We investigated whether the excess risk of death and cardiovascular events among patients with type 2 diabetes could be reduced or eliminated. METHODS In a cohort study, we included 271,174 patients with type 2 diabetes who were registered in the Swedish National Diabetes Register and matched them with 1,355,870 controls on the basis of age, sex, and county. We assessed patients with diabetes according to age categories and according to the presence of five risk factors (elevated glycated hemoglobin level, elevated low-density lipoprotein cholesterol level, albuminuria, smoking, and elevated blood pressure). Cox regression was used to study the excess risk of outcomes (death, acute myocardial infarction, stroke, and hospitalization for heart failure) associated with smoking and the number of variables outside target ranges. We also examined the relationship between various risk factors and cardiovascular outcomes. RESULTS The median follow-up among all the study participants was 5.7 years, during which 175,345 deaths occurred. Among patients with type 2 diabetes, the excess risk of outcomes decreased stepwise for each risk-factor variable within the target range. Among patients with diabetes who had all five variables within target ranges, the hazard ratio for death from any cause, as compared with controls, was 1.06 (95% confidence interval [CI], 1.00 to 1.12), the hazard ratio for acute myocardial infarction was 0.84 (95% CI, 0.75 to 0.93), and the hazard ratio for stroke was 0.95 (95% CI, 0.84 to 1.07). The risk of hospitalization for heart failure was consistently higher among patients with diabetes than among controls (hazard ratio, 1.45; 95% CI, 1.34 to 1.57). In patients with type 2 diabetes, a glycated hemoglobin level outside the target range was the strongest predictor of stroke and acute myocardial infarction; smoking was the strongest predictor of death. CONCLUSIONS Patients with type 2 diabetes who had five risk-factor variables within the target ranges appeared to have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population.

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