Congenital Heart Disease With and Without Cyanotic Potential and the Long‐term Risk of Diabetes Mellitus: A Population‐Based Follow‐up Study

Abstract

BackgroundLong‐term survival for persons born with congenital heart disease (CHD) is improved, but limited knowledge exists of this growing population's acquired cardiovascular risk profile. This study's purpose was to assess CHD survivors’ risk for type 2 diabetes mellitus (T2DM) with attention to the impact of cyanotic CHD.Methods and ResultsThis population‐based cohort study included Danish subjects with CHD who were born between 1963 and 1980 and were alive at age 30 years. For each CHD case, we identified 10 individuals from the general population matched by sex and birth year, by using the Danish Civil Registration System. Complete follow‐up was obtained through Danish public registries for death, emigration, and T2DM (diagnosis and prescriptions record). We computed cumulative incidences and hazard ratios of developing T2DM after age 30 for 5149 CHD subjects compared with the general population. After adjusting for CHD severity, as well as age, sex, preterm birth, and extracardiac defects, we analyzed the impact of cyanotic compared with acyanotic CHD. By age 45 years, the cumulative incidence of T2DM after age 30 was 4% among subjects with CHD. Subjects with CHD were more likely to develop T2DM than the general population (hazard raio 1.4, 95% CI 1.1–1.6). Subjects CHD who had cyanotic defects were more likely to develop T2DM than were subjects with acyanotic CHD (hazard ratio 1.9, 95% CI 1.1–3.3).Conclusions CHD survivors had an increased risk of developing T2DM after age 30. Patients with cyanotic CHD are at particular risk. Given the cardiovascular health burden of T2DM, attention to its development in CHD survivors seems warranted.

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

“…289 A population-based study from Denmark showed new onset of DM in 4% between 30 and 45 years of age with a hazard ratio of 1.35 of new DM in adults with CHD compared with the general population. 303 This study noted that this risk was concentrated in individuals with repaired cyanotic CHD (hazard ratio, 2.85), although the reasons remain unclear. Impaired glucose tolerance and prediabetes have been demonstrated in almost 40% of adults with CHD.…”

Cardiovascular risk factors in adults with coarctation of the aorta

“…Decreased glucose tolerance on oral glucose tolerance test (OGTT) is more common in patients with complex ACHD compared with healthy controls . Furthermore, register studies have reported a higher prevalence of diabetes mellitus in patients with ACHD compared with controls . Patients with ACHD have an increased risk of metabolic syndrome compared with controls and obesity is as common in patients with ACHD as in the general population .…”

Cyanotic congenital heart disease and atherosclerosis

“…Though, it is well known that patients with CCHD are limited in their physical activity due to their chronic hypoxia. A recent published study showed that patients with CCHD have an increased risk of developing type 2 diabetes mellitus 34. Among the four studies on CCHD and atherosclerosis (figure 1), Ciftel et al and Duffel et al reported no difference in body mass index 6 7.…”