Hallström Sara, Wijkman Magnus Olof, Ludvigsson Johnny, Ekman Per, Pfeffer Marc Alan, Wedel Hans, Rosengren Annika, Lind Marcus
Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
Lancet Reg Health Eur. 2022 Jul 22;21:100469. doi: 10.1016/j.lanepe.2022.100469. eCollection 2022 Oct.
Historically, the incidence of cardiovascular disease and mortality in persons with Type 1 diabetes (T1D) has been increased compared to the general population. Contemporary studies on time trends of mortality and cardiovascular disease are sparse.
In this observational study, T1D persons were identified in the Swedish National Diabetes Registry (=45,575) and compared with matched controls from the general population (=220,141). Incidence rates from 2002 to 2019 were estimated with respect to mortality and cardiovascular disease in persons with T1D overall and when stratified for prevalent cardiovascular and renal disease relative to controls.
Mean age in persons with T1D was 32.4 years and 44.9% (20,446/45,575) were women. Age- and sex- adjusted mortality rates declined over time in both groups but remained significantly higher in those with T1D compared to controls during 2017-2019, 7.62 (95% CI 7.16; 8·08) vs. 2.23 (95% CI 2.13; 2.33) deaths per 1,000 person years. Myocardial infarction, heart failure and stroke decreased over time in both groups, with persistent excess risks in the range of 3.4-5.0 times from 2017 to 2019 in those with T1D. T1D persons ≥45 years without previous renal or cardiovascular complications had standardized mortality rates similar or even lower than controls 5.55 (4.51; 6.60) vs.7.08 (6.75; 7.40) respectively in the last time period.
Excess mortality persisted over time in persons with T1D, largely in patients with cardiorenal complications. Improved secondary prevention with a focus on individualized treatment is needed to close the gap in mortality for individuals with T1D.
This study was financed by grants from the ALF-agreement, NovoNordisk Foundation and the Swedish Heart and Lung Foundation.
从历史上看，1型糖尿病（T1D）患者的心血管疾病发病率和死亡率高于普通人群。关于死亡率和心血管疾病时间趋势的当代研究较少。
在这项观察性研究中，从瑞典国家糖尿病登记处识别出T1D患者（=45575例），并与来自普通人群的匹配对照（=220141例）进行比较。估计了2002年至2019年期间T1D患者总体以及根据是否患有心血管和肾脏疾病分层后的死亡率和心血管疾病发病率，并与对照组进行比较。
T1D患者的平均年龄为32.4岁，女性占44.9%（20446/45575）。两组的年龄和性别调整死亡率均随时间下降，但在2017 - 2019年期间，T1D患者的死亡率仍显著高于对照组，分别为每1000人年7.62例（95%置信区间7.16；8.08）和2.23例（95%置信区间2.13；2.33）死亡。两组的心肌梗死、心力衰竭和中风发病率均随时间下降，但在2017年至2019年期间，T1D患者的持续超额风险在3.4至5.0倍之间。在最后一个时间段，年龄≥45岁且无既往肾脏或心血管并发症的T1D患者的标准化死亡率与对照组相似，甚至更低，分别为5.55（4.51；6.60）和7.08（6.75；7.40）。
T1D患者的超额死亡率长期存在，主要存在于患有心肾并发症的患者中。需要加强以个体化治疗为重点的二级预防，以缩小T1D患者与普通人群之间的死亡率差距。
本研究由ALF协议、诺和诺德基金会以及瑞典心肺基金会提供的赠款资助。
