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Glycaemic control and excess risk of major coronary events in persons with type 1 diabetes

Artikel i vetenskaplig tidskrift
Författare Viktorija Matuleviciene Anängen
Annika Rosengren
A. M. Svensson
A. Pivodic
Soffia Gudbjörnsdottir
Hans Wedel
M. Kosiborod
Börje Haraldsson
Marcus Lind
Publicerad i Heart
Volym 103
Nummer/häfte 21
Sidor 1687-1695
ISSN 1355-6037
Publiceringsår 2017
Publicerad vid Institutionen för neurovetenskap och fysiologi, sektionen för fysiologi
Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, enheten för hälsometri
Sidor 1687-1695
Språk en
Länkar dx.doi.org/10.1136/heartjnl-2016-31...
Ämnesord Adolescent, Adult, Age Factors, Aged, Biomarkers/blood, Blood Glucose/*drug effects/metabolism, Diabetes Mellitus, Type 1/blood/complications/*drug therapy/mortality, Diabetic Nephropathies/etiology/mortality, Female, Glycated Hemoglobin A/metabolism, Humans, Hypoglycemic Agents/adverse effects/*therapeutic use, Male, Middle Aged, Myocardial Infarction/diagnosis/etiology/mortality/*prevention & control, Registries, Risk Assessment, Risk Factors, Sex Factors, Sweden, Time Factors, Treatment Outcome, Young Adult, blood glucose, coronary disease, diabetes complications, diabetes mellitus, myocardial infarction, type1, AstraZeneca, Eli Lilly, Medtronic, Novo Nordisk and Pfizer and grant support from, AstraZeneca, Dexcom, Novo Nordisk and Pfizer. All other authors declare no, conflicts of interest.
Ämneskategorier Diabetologi, Kardiovaskulär medicin

Sammanfattning

OBJECTIVE: The excess risk of major coronary events (acute myocardial infarction (AMI) or death from coronary heart disease (CHD)) in individuals with type 1 diabetes (T1D) in relation to glycaemic control and renal complications is not known. METHODS: Individuals with T1D in the Swedish National Diabetes Registry after 1 January 1998, without a previous MI (n=33 170) and 1 64 698 controls matched on age, sex and county were followed with respect to non-fatal AMI or death from CHD. Data were censored at death due to any cause until 31 December 2011. RESULTS: During median follow-up of 8.3 and 8.9 years for individuals with T1D and controls, respectively, 1500 (4.5%) and 1925 (1.2%), experienced non-fatal AMI or died from CHD, adjusted HR 4.07 (95% CI 3.79 to 4.36). This excess risk increased with younger age, female sex, worse glycaemic control and severity of renal complications.The adjusted HR in men with T1D with updated mean haemoglobin A1c (HbA1c) <6.9% (52 mmol/mol) and normoalbuminuria was 1.30 (95% CI 0.90 to 1.88) and in women 3.16 (95% CI 2.14 to 4.65). HRs increased to 10.7 (95% CI 8.0 to 14.3) and 31.8 (95% CI 23.6 to 42.8) in men and women, respectively, with HbA1c >9.7% and renal complications. CONCLUSIONS: The excess risk of AMI in T1D is substantially lower with good glycaemic control, absence of renal complications and men compared with women. In women, the excess risk of AMI or CHD death persists even among patients with good glycaemic control and no renal complications.

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