Association Between Use of Lipid-Lowering Therapy and Cardiovascular Diseases and Death in Individuals With Type 1 Diabetes

Hero, Christel; Rawshani, Araz; Svensson, Ann‐Marie; Franzén, Stefan; Eliasson, Björn; Eeg‐Olofsson, Katarina; Guðbjörnsdóttir, Soffia

doi:10.2337/dc15-2450

Cited by 60 publications

(37 citation statements)

References 23 publications

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“…The Swedish National Diabetes Registry (NDR), initiated in 1996, is a quality assurance tool with nationwide coverage, with informed consent from all participants. The registry includes data on risk factors and medication provided by trained health care professionals (9,10) and continuous work to improve the validity of the data (11). Through the personal identity number assigned to all Swedish residents (12), we linked the following Swedish national registers: the NDR; Inpatient Registry (IPR), which is part of the National Patient Register (13); the Cause of Death Registry; and the Longitudinal Database for Health Insurance and Labor Market.…”

Section: Data Sourcesmentioning

confidence: 99%

BMI, Mortality, and Cardiovascular Outcomes in Type 1 Diabetes: Findings Against an Obesity Paradox

Edqvist

Rawshani

Adiels³

et al. 2019

Diabetes Care

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OBJECTIVELow weight has been associated with increased mortality risks in type 1 diabetes. We aimed to investigate the importance of weight and weight gain/loss in the Swedish population diagnosed with type 1 diabetes. RESEARCH DESIGN AND METHODSPatients with type 1 diabetes (n = 26,125; mean age 33.3 years; 45% women) registered in the Swedish National Diabetes Registry from 1998 to 2012 were followed from the first day of study entry. Cox regression was used to calculate risk of death from cardiovascular disease (CVD), major CVD events, hospitalizations for heart failure (HF), and total deaths. RESULTSPopulation mean BMI in patients with type 1 diabetes increased from 24.7 to 25.7 kg/m 2 from 1998 to 2012. Over a median follow-up of 10.9 years, there were 1,031 deaths (33.2% from CVD), 1,460 major CVD events, and 580 hospitalizations for HF. After exclusion of smokers, patients with poor metabolic control, and patients with a short follow-up time, there was no increased risk for mortality in those with BMI <25 kg/m 2 , while BMI >25 kg/m 2 was associated with a minor increase in risk of mortality, major CVD, and HF. In women, associations with BMI were largely absent. Weight gain implied an increased risk of mortality and HF, while weight loss was not associated with higher risk. CONCLUSIONSRisk of major CVD, HF, CVD death, and mortality increased with increasing BMI, with associations more apparent in men than in women. After exclusion of factors associated with reverse causality, there was no evidence of an obesity paradox.Recent studies suggest that insulin resistance in overweight or obese individuals with type 1 diabetes may be associated with an increased risk of vascular complications (1), but few studies have investigated the relationship between BMI in individuals with type 1 diabetes and mortality. Phenomena such as the obesity paradox, which suggests that there is an inverse association between BMI and risk of cardiovascular outcomes, have been debated intensely in the past decade (2). Also, the prevalence of obesity in the general Swedish population has increased steadily over past decades (3), and for patients with type 1 diabetes, weight gain is a potential side effect of intensive insulin therapy, which is the mainstay of modern management (4). Hence, to our

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Section: Data Sourcesmentioning

confidence: 99%

BMI, Mortality, and Cardiovascular Outcomes in Type 1 Diabetes: Findings Against an Obesity Paradox

Edqvist

Rawshani

Adiels³

et al. 2019

Diabetes Care

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“…The underlying mechanisms are only partly understood and even when traditional risk factors for CVD have been addressed, patients with diabetes bear significant residual risk for CVD [3]. …”

Section: Introductionmentioning

confidence: 99%

Reduced HDL function in children and young adults with type 1 diabetes

Heier

Borja²,

Brunborg

et al. 2017

Cardiovasc Diabetol

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BackgroundPatients with type 1 diabetes (T1D) are at increased risk of cardiovascular disease (CVD). Measures of high-density lipoprotein (HDL) function provide a better risk estimate for future CVD events than serum levels of HDL cholesterol. The objective of this study was to evaluate HDL function in T1D patients shortly after disease onset compared with healthy control subjects.MethodsParticipants in the atherosclerosis and childhood diabetes study were examined at baseline and after 5 years. At baseline, the cohort included 293 T1D patients with a mean age of 13.7 years and mean HbA1c of 8.4%, along with 111 healthy control subjects. Their HDL function, quantified by HDL-apoA-I exchange (HAE), was assessed at both time points. HAE is a measure of HDL’s dynamic property, specifically its ability to release lipid-poor apolipoprotein A-I (apoA-I), an essential step in reverse cholesterol transport.ResultsThe HAE-apoA-I ratio, reflecting the HDL function per concentration unit apoA-I, was significantly lower in the diabetes group both at baseline, 0.33 (SD = 0.06) versus 0.36 (SD = 0.06) %HAE/mg/dL, p < 0.001 and at follow-up, 0.34 (SD = 0.06) versus 0.36 (SD = 0.06) %HAE/mg/dL, p = 0.003. HAE-apoA-I ratio was significantly and inversely correlated with HbA1c in the diabetes group. Over the 5 years of the study, the mean HAE-apoA-I ratio remained consistent in both groups. Individual changes were less than 15% for half of the study participants.ConclusionsThis study shows reduced HDL function, quantified as HAE-apoA-I ratio, in children and young adults with T1D compared with healthy control subjects. The differences in HDL function appeared shortly after disease onset and persisted over time.

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“…4 Landmark studies such as the Diabetes Control and Complications Trial, United Kingdom Prospective Diabetes Study, Collaborative Atorvastatin Diabetes Study, and several others have shown the importance of glucose-lowering therapy, statin use, blood-pressure control, and multifactorial intervention in reducing the risk of cardiovascular outcomes among patients with diabetes. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] These trial results and the clinical application of their findings, along with lifestyle interventions (including smoking cessation), are likely to have improved outcomes in patients with diabetes during the past two decades. We set out to investigate the long-term trends (1998 through 2014) in all-cause mortality and the incidence of major diabetes-related cardiovascular complications, as compared with contemporary trends in the general population.…”

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confidence: 99%

Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes

et al. 2017

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BACKGROUNDLong-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. METHODSWe 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. RESULTSAmong 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. CONCLUSIONSIn 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. (Funded by the Swedish Association of Local Authorities and Regions and others.) a bs tr ac t

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Association Between Use of Lipid-Lowering Therapy and Cardiovascular Diseases and Death in Individuals With Type 1 Diabetes

Cited by 60 publications

References 23 publications

BMI, Mortality, and Cardiovascular Outcomes in Type 1 Diabetes: Findings Against an Obesity Paradox

BMI, Mortality, and Cardiovascular Outcomes in Type 1 Diabetes: Findings Against an Obesity Paradox

Reduced HDL function in children and young adults with type 1 diabetes

Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes

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