Ten-year cardiovascular mortality in relation to risk factors and abnormalities in lipoprotein composition in Type 2 (non-insulin-dependent) diabetic and non-diabetic subjects

Abstract

The purpose of the present study was to examine 10-year cardiovascular morbidity and mortality in patients with newly-diagnosed Type 2 (non-insulin-dependent) diabetes mellitus and non-diabetic control subjects and to evaluate the effects of general risk factors, plasma insulin, urinary albumin excretion, lipoprotein abnormalities characteristic of Type 2 diabetes and the degree of hyperglycaemia in diabetic patients on cardiovascular mortality. Furthermore, the extent to which the above-mentioned factors could contribute to the excessive cardiovascular mortality observed in diabetic patients was examined. In the years 1979-1981, altogether 133 (70 men, 63 women) newly-diagnosed patients with Type 2 diabetes and 144 (62 men, 82 women) non-diabetic control subjects aged 45-64 years were studied. Both groups were re-examined in the years 1985-1986 and 1991-1992. The impact of different factors on cardiovascular mortality was examined by univariate analyses after adjustment for age and sex and by multiple logistic regression analyses. The age-standardized total and cardiovascular mortality rates were substantially higher in diabetic men (17.8 and 15.0%, total and cardiovascular mortality, respectively p = 0.06 and NS) and women (18.5 and 16.6%, p < 0.01 for both) than in non-diabetic control men (5.2% both total and cardiovascular mortality) and women (4.2 and 2.2%). Cardiovascular mortality was not related to the treatment modality (diet, oral drugs, insulin) at 5 years from diagnosis. Use of diuretics, beta-blocking agents or their combination at baseline did not make a significant contribution to cardiovascular mortality either. In multiple logistic regression analysis on diabetic patients, age, LDL triglycerides, smoking, blood glucose and ischaemic ECG at baseline had independent associations with cardiovascular mortality. Interestingly, urinary albumin excretion rate measured at 5-year examination also predicted 10-year cardiovascular mortality after adjustment for the effects of major risk factors including lipoprotein abnormalities, but its predictive power reduced to a nonsignificant level when the effect of plasma glucose was taken into account. The relative risk of cardiovascular mortality associated with diabetes was 8.2 after allowing for age alone, but it declined to 3.7 when all contributing factors from the baseline examination (except blood glucose) were taken into account. In conclusion, the present results indicate that LDL triglycerides and/or other changes in lipoprotein composition characteristic of Type 2 diabetes and manifesting as elevated serum triglycerides are atherogenic and they strongly predict increased cardiovascular mortality.(ABSTRACT TRUNCATED AT 400 WORDS)

Synergistic effect of polymorphisms in uncoupling protein 1 and β 3 -adrenergic receptor genes on basal metabolic rate in obese Finns

“…The frequencies of the A to G polymorphism of the UCP1 gene and Trp64Arg polymorphism of the b 3 -AR gene were compared among the study subjects with a group of 112 (53 men, 59 women) population-based non-diabetic control subjects who were recruited from 180 000 inhabitants of the county of Kuopio in eastern Finland [18].…”

Recommendations for the nutritional management of patients with diabetes mellitus

“…In addition, the syndrome of low HDL-with high triglycerides, seen even in well treated NIDDM (Manzato et al, 1993), contributes to the risk of mortality (Fontbonne et al, 1991;Uusitupa et al, 1993).…”

“…Epidemiological evidence suggests that people with diabetes in populations consuming low fat diets have a reduced morbidity and mortality (Uusitupa et al, 1993). In Europe, the average person with IDDM diabetes has a saturated fatty acid intake of 14 ±17% dietary energy (Toeller et al, 1996;Toeller, 1993).…”

Detection of monocyte-derived microparticles in patients with Type II diabetes mellitus

“…Atherosclerosis is the major cause of death in patients with diabetes mellitus, leading to a high mortality rate in all forms of the disease [5]. Classical risk factors, including hyperlipidaemia, hypertension, and obesity, do not completely account for the increased incidence of atherosclerosis associated with diabetes [6]. Recent reports suggest that increased expression of endothelial adhesion Diabetologia (2002) Results.…”