Effects of fasting blood glucose, diabetes treatment, blood pressure and anti-hypertension treatment on cardiovascular disease incidence: a 30-year follow-up study of 740 incident patients with Type 2 diabetes.

AIMS

To analyse the effects of hyperglycaemia and blood pressure, diabetes and anti-hypertension treatment on total and various types of cardiovascular disease incidence in patients with Type 2 diabetes followed for 30 years.

METHODS

A total of 740 incident patients with Type 2 diabetes were registered at the Laxå Primary Health Care Centre, Sweden between 1972 and 2001. Information on systolic, diastolic, and mean arterial blood pressure, mean fasting blood glucose, type of diabetes and anti-hypertension treatment was obtained from the patient records, and information on cardiovascular disease, myocardial infarction and stroke events from National Registers.

RESULTS

During the follow-up period the cumulative incidence of cardiovascular disease increased significantly with male sex (HR 1.52, 95% CI 1.25-1.85), age (HR 1.05, 95% CI 1.04-1.07), year of diabetes onset (HR 1.03, 95% CI 1.01-1.05), BMI, (HR 1.04, 95% CI 1.02-1.07), mean arterial blood pressure (HR 1.04, 95% CI 1.02-1.05) and number of previous cardiovascular disease events (HR 1.15, 95% CI 1.10-1.21), and decreased significantly with sulfonylurea treatment (HR 0.64, 95% CI 0.49-0.84), insulin (HR 0.57, 95% CI 0.33-0.98) and calcium channel blocker treatment (HR, 0.69, 95% CI 0.48-0.99). Cumulative incidence of myocardial infarction increased significantly with male sex, age, BMI, mean arterial blood pressure, number of previous myocardial infarction events and diuretic treatment, and decreased with metformin treatment. Cumulative incidence of stroke increased with age, year of diabetes onset, mean arterial blood pressure, and previous number of stroke events.

CONCLUSIONS

Cumulative cardiovascular disease, myocardial infarction and incidence of stroke increased with number of previous events and presence of hypertension and decreased with pharmacological anti-diabetic treatment and, to a lesser extent, with anti-hypertension treatment.