Risk of early mortality and cardiovascular disease in type 1 diabetes: a comparison with type 2 diabetes, a nationwide study

Abstract

BackgroundBoth type 1 and type 2 diabetes are well-established risk factors for cardiovascular disease and early mortality. However, few studies have directly compared the hazards of cardiovascular outcomes and premature death among people with type 1 diabetes to those among people with type 2 diabetes and subjects without diabetes. Furthermore, information about the hazard of cardiovascular disease and early mortality among Asians with type 1 diabetes is sparse, although the clinical and epidemiological characteristics of Asians with type 1 diabetes are unlike those of Europeans. We estimated the hazard of myocardial infarction (MI), hospitalization for heart failure (HF), atrial fibrillation (AF), and mortality during follow-up in Korean adults with type 1 diabetes compared with those without diabetes and those with type 2 diabetes.MethodsWe used Korean National Health Insurance Service datasets of preventive health check-ups from 2009 to 2016 in this retrospective longitudinal study. The hazard ratios of MI, HF, AF, and mortality during follow-up were analyzed using the Cox regression analyses according to the presence and type of diabetes in ≥ 20-year-old individuals without baseline cardiovascular disease (N = 20,423,051). The presence and type of diabetes was determined based on the presence of type 1 or type 2 diabetes at baseline.ResultsDuring more than 93,300,000 person-years of follow-up, there were 116,649 MIs, 135,532 AF cases, 125,997 hospitalizations for HF, and 344,516 deaths. The fully-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident MI, hospitalized HF, AF, and all-cause death within the mean follow-up of 4.6 years were higher in the type 1 diabetes group than the type 2 diabetes [HR (95% CI) 1.679 (1.490–1.893) for MI; 2.105 (1.901–2.330) for HF; 1.608 (1.411–1.833) for AF; 1.884 (1.762–2.013) for death] and non-diabetes groups [HR (95% CI) 2.411 (2.138–2.718) for MI; 3.024 (2.730–3.350) for HF; 1.748 (1.534–1.993) for AF; 2.874 (2.689–3.073) for death].ConclusionsIn Korea, the presence of diabetes was associated with a higher hazard of cardiovascular disease and all-cause death. Specifically, people with type 1 diabetes had a higher hazard of cardiovascular disease and all-cause mortality compared to people with type 2 diabetes.

Hospitalization for heart failure incidence according to the transition in metabolic health and obesity status: a nationwide population-based study

“…The endpoint was incidence of hHF. The hHF was defined as the first hospitalization under a primary diagnosis of ICD-10 code I50 as reported in previous studies [23][24][25]. The study population was followed up from baseline (the date of the second health examination between 2013 and 2014) until the date of death, development of hHF, or December 31, 2017, whichever came first.…”

Evaluation of cardiovascular risk in adults with type 1 diabetes: poor concordance between the 2019 ESC risk classification and 10-year cardiovascular risk prediction according to the Steno Type 1 Risk Engine

“…Worldwide estimates of numbers of individuals with Type 1 diabetes (T1D) continue to increase [1]. Among other reasons, this is particularly worrisome since adults with T1D have an almost threefold higher mortality compared to the general population, largely due to premature cardiovascular disease (CVD) [2][3][4][5][6][7]. In this respect, even in children and young adults with T1D, there is evidence of cardiac and vascular dysfunction, as supported by the presence of abnormal global myocardial function, stiffening of large arteries, and early atherosclerosis [8].…”

Commentary on risk factors for first and subsequent cardiovascular disease events in type 1 diabetes: The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study

“…analyzed the data of 26,026 type 1 diabetes patients in the Scottish nationwide diabetes register during 2005–2007, and found that the contemporary relative risk of coronary heart disease and stroke among type 1 diabetes patients remains exceptionally high when compared with the general population, although the absolute incidence of CVD was lower than previously reported. In East Asia, Lee et al 2 . analyzed the Korean health insurance data, and reported that the incidence of myocardial infarction and the rate of hospitalization for heart failure were even higher than those of type 2 diabetes patients.…”