Till sidans topp

Sidansvarig: Webbredaktion
Sidan uppdaterades: 2012-09-11 15:12

Tipsa en vän
Utskriftsversion

Excess mortality and card… - Göteborgs universitet Till startsida
Webbkarta
Till innehåll Läs mer om hur kakor används på gu.se

Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study

Artikel i vetenskaplig tidskrift
Författare Araz Rawshani
N. Sattar
S. Franzen
A. Rawshani
A. T. Hattersley
A. M. Svensson
Björn Eliasson
S. Gudbjornsdottir
Publicerad i The Lancet
Volym 392
Nummer/häfte 10146
Sidor 477-486
ISSN 0140-6736
Publiceringsår 2018
Publicerad vid Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition
Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 477-486
Språk en
Länkar dx.doi.org/10.1016/s0140-6736(18)31...
Ämnesord American-Heart-Association, glycemic control, endothelial dysfunction, scientific statement, general-population, lowering therapy, mellitus, children, individuals, thickness
Ämneskategorier Diabetologi, Kardiologi

Sammanfattning

Background People with type 1 diabetes are at elevated risk of mortality and cardiovascular disease, yet current guidelines do not consider age of onset as an important risk stratifier. We aimed to examine how age at diagnosis of type 1 diabetes relates to excess mortality and cardiovascular risk. Methods We did a nationwide, register-based cohort study of individuals with type 1 diabetes in the Swedish National Diabetes Register and matched controls from the general population. We included patients with at least one registration between Jan 1, 1998, and Dec 31, 2012. Using Cox regression, and with adjustment for diabetes duration, we estimated the excess risk of all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, acute myocardial infarction, stroke, cardiovascular disease (a composite of acute myocardial infarction and stroke), coronary heart disease, heart failure, and atrial fibrillation. Individuals with type 1 diabetes were categorised into five groups, according to age at diagnosis: 0-10 years, 11-15 years, 16-20 years, 21-25 years, and 26-30 years. Findings 27 195 individuals with type 1 diabetes and 135 178 matched controls were selected for this study. 959 individuals with type 1 diabetes and 1501 controls died during follow-up (median follow-up was 10 years). Patients who developed type 1 diabetes at 0-10 years of age had hazard ratios of 4.11 (95% CI 3.24-5.22) for all-cause mortality, 7.38 (3.65-14.94) for cardiovascular mortality, 3.96 (3.06-5.11) for non-cardiovascular mortality, 11.44 (7.95-16.44) for cardiovascular disease, 30.50 (19.98-46.57) for coronary heart disease, 30.95 (17.59-54.45) for acute myocardial infarction, 6.45 (4.04-10.31) for stroke, 12.90 (7.39-22.51) for heart failure, and 1.17 (0.62-2.20) for atrial fibrillation. Corresponding hazard ratios for individuals who developed type 1 diabetes aged 26-30 years were 2.83 (95% CI 2.38-3.37) for all-cause mortality, 3.64 (2.34-5.66) for cardiovascular mortality, 2.78 (2.29-3.38) for non-cardiovascular mortality, 3.85 (3.05-4.87) for cardiovascular disease, 6.08 (4.71-7.84) for coronary heart disease, 5.77 (4.08-8.16) for acute myocardial infarction, 3.22 (2.35-4.42) for stroke, 5.07 (3.55-7.22) for heart failure, and 1.18 (0.79-1.77) for atrial fibrillation; hence the excess risk differed by up to five times across the diagnosis age groups. The highest overall incidence rate, noted for all-cause mortality, was 1.9 (95% CI 1.71-2.11) per 100 000 person-years for people with type 1 diabetes. Development of type 1 diabetes before 10 years of age resulted in a loss of 17.7 life-years (95% CI 14.5-20.4) for women and 14.2 life-years (12.1-18.2) for men. Interpretation Age at onset of type 1 diabetes is an important determinant of survival, as well as all cardiovascular outcomes, with highest excess risk in women. Greater focus on cardioprotection might be warranted in people with early-onset type 1 diabetes. Funding Swedish Heart and Lung Foundation. Copyright (c) 2018 Elsevier Ltd. All rights reserved.

Sidansvarig: Webbredaktion|Sidan uppdaterades: 2012-09-11
Dela:

På Göteborgs universitet använder vi kakor (cookies) för att webbplatsen ska fungera på ett bra sätt för dig. Genom att surfa vidare godkänner du att vi använder kakor.  Vad är kakor?