Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes

Abstract

Aims/hypothesis. Although ischaemic heart disease is the predominant cause of mortality in older people with diabetes, age-specific mortality rates have not been published for patients with Type 1 diabetes. The Diabetes UK cohort, essentially one of patients with Type 1 diabetes, now has sufficient follow-up to report all heart disease, and specifically ischaemic heart disease, mortality rates by age. Methods. A cohort of 23,751 patients with insulintreated diabetes, diagnosed under the age of 30 years and from throughout the United Kingdom, was identified during the period 1972 to 1993 and followed for mortality until December 2000. Age-and sex-specific heart disease mortality rates and standardised mortality ratios were calculated. Results. There were 1437 deaths during the follow-up, 536 from cardiovascular disease, and of those, 369 from ischaemic heart disease. At all ages the ischaemic heart disease mortality rates in the cohort were higher than in the general population. Mortality rates within the cohort were similar for men and women under the age of 40. The standardised mortality ratios were higher in women than men at all ages, and in women were 44.8 (95%CI 20.5-85.0) at ages 20-29 and 41.6 (26.7-61.9) at ages 30-39. Conclusions/interpretation. The risk of mortality from ischaemic heart disease is exceptionally high in young adult women with Type 1 diabetes, with rates similar to those in men with Type 1 diabetes under the age of 40. These observations emphasise the need to identify and treat coronary risk factors in these young patients. [Diabetologia (2003) 46:760-765]

Changes in glycaemic control and risk of coronary artery disease in type 1 diabetes mellitus: findings from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC)

“…Data from the WESDR and the Hvidore hospital studies [3,4,9] were not included in this analysis since baseline values for CAD cases and non-cases are not currently published.…”

“…These observations are especially true for those with type 1 diabetes mellitus, in whom coronary heart disease is increased tenfold or greater [2,3]. However, while the role of glycaemia in the development of microvascular diabetes complications, such as retinopathy and albuminuria, is well established [4,5], its role in CVD in patients with type 1 diabetes remains unclear.…”

Levels of soluble receptor for AGE are cross-sectionally associated with cardiovascular disease in type 1 diabetes, and this association is partially mediated by endothelial and renal dysfunction and by low-grade inflammation: the EURODIAB Prospective Complications Study

“…The increased cardiovascular disease (CVD) risk in individuals with diabetes mellitus cannot be fully explained by traditional cardiovascular risk factors [1,2]. Therefore, other factors and mechanisms potentially involved need to be explored.…”

Children and adolescents with type 1 diabetes eat a more atherosclerosis-prone diet than healthy control subjects

“…It is well established that type 1 diabetic children and adolescents have an increased risk of cardiovascular disease compared to the general population [1,2]. The multi-centre study EURODIAB found that low intake of saturated fat and high intake of fibre reduced the risk of cardiovascular disease among type 1 diabetic subjects [3,4].…”