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Type 1 diabetes increases post-CABG mortality risk
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Patients with type 1 diabetes appear to have twice the risk for death after undergoing CABG than patients without type 1 diabetes, according to recent findings.
Type 2 diabetes confers only a slightly increased post-CABG mortality risk, the researchers wrote.
In an observational, population-based cohort study in Sweden, researchers evaluated 39,235 patients (mean age, 67 years; 21% women) enrolled in the SWEDEHEART registry who underwent primary, isolated, non-emergency CABG between 2003 and 2013. The cohort included 725 patients with type 1 diabetes and 8,208 with type 2 diabetes.
During a mean follow-up of 5.9 ± 3.2 years, 6,765 patients died (17%). This included 21% of patients with type 1 diabetes, 19% of those with type 2 diabetes and 17% of those with no diabetes. The adjusted HR for death was 2.04 (95% CI, 1.72-2.42) among those with type 1 diabetes and 1.11 (95% CI, 1.05-1.18) among patients with type 2 diabetes compared with those without diabetes. Mortality risk was similarly elevated among men and women with type 1 diabetes (HR = 1.83; 95% CI, 1.45-2.3 for men and HR = 2.17; 95% CI, 1.66-2.84 for women).
Patients with type 1 diabetes also were at significantly higher risk for all-cause mortality than patients with type 2 diabetes (adjusted HR = 1.7; 95% CI, 1.4-2.06). The addition of HbA1c and disease duration to the multivariable model partially attenuated but did not eliminate this association (adjusted HR = 1.44; 95% CI, 1.14-1.8).
Analysis according to cause of death indicated a stronger correlation between type 1 diabetes and non-CV-related mortality than with CV-related mortality, the researchers wrote. Type 2 diabetes was not significantly associated with CV-related death (HR = 1.08; 95% CI, 0.95-1.19).
“Our data indicate that patients with [type 1 diabetes] are at high risk for adverse outcome after CABG and should be closely followed up, and that all possible measures to mitigate their risk of death or recurrent CV events should be instituted,” the researchers concluded.
In a related editorial, David P. Taggart, MD, PhD of the department of cardiac surgery, Oxford University Hospitals Trust in Oxford, United Kingdom, wrote that the researchers had provided a large, “virtually complete” representation of the Swedish population through contemporary national registers.
“As such, the results could be confidently applied to patients with [diabetes] undergoing CABG in similar developed health care systems,” Taggart wrote. “And the main message of the study is that the ‘low-hanging fruit’ is the need to focus on both the increased incidence of CV and non-CV deaths in patients with type 1 diabetes.” –by Jennifer Byrne
Disclosure: The researchers and Taggart report no relevant financial disclosures.
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