Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden (A. Rawshani, A. Rawshani, B.E., A. Rosengren, S.G.).
Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden (A. Rawshani, A. Rawshani, S.F., B.E., A.-M.S., M.M., S.G.).
Circulation. 2019 Apr 16;139(16):1900-1912. doi: 10.1161/CIRCULATIONAHA.118.037454.
The strength of association and optimal levels for risk factors related to excess risk of death and cardiovascular outcomes in type 1 diabetes mellitus have been sparsely studied.
In a national observational cohort study from the Swedish National Diabetes Register from 1998 to 2014, we assessed relative prognostic importance of 17 risk factors for death and cardiovascular outcomes in individuals with type 1 diabetes mellitus. We used Cox regression and machine learning analyses. In addition, we examined optimal cut point levels for glycohemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol. Patients with type 1 diabetes mellitus were followed up until death or study end on December 31, 2013. The primary outcomes were death resulting from all causes, fatal/nonfatal acute myocardial infarction, fatal/nonfatal stroke, and hospitalization for heart failure.
Of 32 611 patients with type 1 diabetes mellitus, 1809 (5.5%) died during follow-up over 10.4 years. The strongest predictors for death and cardiovascular outcomes were glycohemoglobin, albuminuria, duration of diabetes mellitus, systolic blood pressure, and low-density lipoprotein cholesterol. Glycohemoglobin displayed ≈2% higher risk for each 1-mmol/mol increase (equating to ≈22% per 1% glycohemoglobin difference), whereas low-density lipoprotein cholesterol was associated with 35% to 50% greater risk for each 1-mmol/L increase. Microalbuminuria or macroalbuminuria was associated with 2 to 4 times greater risk for cardiovascular complications and death. Glycohemoglobin <53 mmol/mol (7.0%), systolic blood pressure <140 mm Hg, and low-density lipoprotein cholesterol <2.5 mmol/L were associated with significantly lower risk for outcomes observed.
Glycohemoglobin, albuminuria, duration of diabetes mellitus, systolic blood pressure, and low-density lipoprotein cholesterol appear to be the most important predictors for mortality and cardiovascular outcomes in patients with type 1 diabetes mellitus. Lower levels for glycohemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol than contemporary guideline target levels appear to be associated with significantly lower risk for outcomes.
1 型糖尿病患者死亡和心血管结局风险因素的关联强度和最佳水平研究甚少。
在一项来自瑞典国家糖尿病登记处 1998 年至 2014 年的全国观察性队列研究中，我们评估了 17 个风险因素对 1 型糖尿病患者死亡和心血管结局的相对预后重要性。我们使用 Cox 回归和机器学习分析。此外，我们还检查了糖化血红蛋白、收缩压和低密度脂蛋白胆固醇的最佳切点水平。1 型糖尿病患者的随访时间截止到 2013 年 12 月 31 日死亡或研究结束。主要结局是所有原因导致的死亡、致死性/非致死性急性心肌梗死、致死性/非致死性卒中和心力衰竭住院。
在 32611 例 1 型糖尿病患者中，1809 例（5.5%）在 10.4 年的随访期间死亡。死亡和心血管结局的最强预测因素是糖化血红蛋白、白蛋白尿、糖尿病病程、收缩压和低密度脂蛋白胆固醇。糖化血红蛋白每增加 1mmol/mol（相当于糖化血红蛋白差异每增加 1%），风险增加约 2%，而低密度脂蛋白胆固醇每增加 1mmol/L，风险增加 35%至 50%。微量白蛋白尿或大量白蛋白尿与心血管并发症和死亡的风险增加 2 至 4 倍相关。糖化血红蛋白<53mmol/mol（7.0%）、收缩压<140mmHg 和低密度脂蛋白胆固醇<2.5mmol/L 与观察到的结局风险显著降低相关。
糖化血红蛋白、白蛋白尿、糖尿病病程、收缩压和低密度脂蛋白胆固醇似乎是 1 型糖尿病患者死亡和心血管结局的最重要预测因素。低于当代指南目标水平的糖化血红蛋白、收缩压和低密度脂蛋白胆固醇水平与结局风险显著降低相关。
