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Cardiometabolic multimorbidity reduces life expectancy
The risk for mortality is similar among patients with diabetes, stroke or MI, but a combination of these conditions was associated with a substantial decrease in life expectancy, according to study findings published in JAMA.
“These results suggest that associations of [CVD] and diabetes with mortality are multiplicative and essentially nonoverlapping,” John Danesh, FMedSci, from the University of Cambridge, and colleagues wrote. “This finding is consistent with previous observations that associations of diabetes with chronic disease outcomes are largely independent of major [CV] risk factors.”
Danesh and colleagues analyzed data collected from 689,300 participants (mean baseline age, 53 years; 51% women) enrolled in the Emerging Risk Factors Collaboration between 1960 and 2007 to estimate the life expectancy of those with cardiometabolic multimorbidity. The researchers stratified the results by sex and used a two-level mixed-effects Poisson regression model to adjust mortality rates to age 60 years — an age at which multimorbidity becomes more common.
At baseline, 3.6% (n = 24,677) of the participants had a history of diabetes, 1.2% (n = 8,583) had stroke, 3.1% (n = 21,591) had MI, 0.5% (n = 3,233) had both diabetes and MI, 0.2% (n = 1,321) had diabetes and stroke, 0.3% (n = 1,836) had stroke and MI, and 0.1% (n = 541) had diabetes, stroke and MI. Nearly 129,000 deaths due to vascular causes (n = 50,595), cancer (n = 39,266) and other (n = 30,664) or unknown causes (n = 8,318) had occurred in this population as of April 2013.
The adjusted mortality rate per 1,000 person-years was 6.8 (95% CI, 6.2-7.4) among participants with no history of cardiometabolic conditions, 15.6 (95% CI, 14.1-17) in those with diabetes, 16.1 (95% CI, 14.4-17.8) among patients with stroke, 16.8 (95% CI, 15.2-18.3) in those with MI, 32 (95% CI, 28.1-35.9) in those with both diabetes and MI, 32.5 (95% CI, 27-37.9) among those with diabetes and stroke, 32.8 (95% CI, 28.1-37.6) in those with stroke and MI, and 59.5 (95% CI, 47-71.9) in participants with diabetes, stroke and MI.
Compared with participants without a history of diabetes or CVD at baseline, all-cause mortality was approximately doubled among patients with diabetes (HR = 1.9; 95% CI, 1.8-2), stroke (HR = 2.1; 95% CI, 2-2.2) or MI (HR = 2; 95% CI, 1.9-2.2); nearly four times greater in participants with both diabetes and MI (HR = 3.7; 95% CI, 3.3-4.1), diabetes and stroke (HR = 3.8; 95% CI, 3.5-4.2) or stroke and MI (HR = 3.5; 95% CI, 3.1-4); and approximately seven times greater among participants with all three conditions (HR = 6.9; 95% CI, 5.7-8.3).
A history of two or three conditions at age 60 years was associated with a 12- to 16-year reduction in life expectancy, similar to that of lifelong smokers and patients with HIV, according to the researchers.
Life expectancy was further reduced in participants with multiple conditions detected at a younger age. For example, men with three conditions by age 40 years lost an estimated 23 years of life vs. an estimated 20 years lost at age 50 years.
Associations between cardiometabolic multimorbidity and mortality varied according to sex. Men with baseline CVD had stronger evidence of reduced life expectancy than women. In contrast, women with baseline diabetes had a stronger correlation vs. men.
The researchers compared their findings with more recent data from UK Biobank, a study that enrolled 499,808 participants from 2006 to 2010 and accrued nearly 8,000 deaths, and observed similar results.
They wrote that the prevalence of cardiometabolic multimorbidity is an increasing issue: Roughly 1% of participants in the study were identified as having multiple conditions vs. approximately 3% from more recent surveys conducted in the United States. – by Stephanie Viguers
Disclosure: Danesh reports receiving personal fees and serving on advisory boards for Merck Sharp and Dohme, Novartis, Pfizer and Sanofi; receiving grants from the BUPA Foundation, diaDexus, Evelyn Trust, Fogarty International Centre, GlaxoSmithKline, Merck, NHLBI, National Institute for Health Research, National Institute of Neurological Disorders and Stroke, NHS Blood and Transplant, Novartis, Pfizer, UK Medical Research Council, University of British Columbia, University of Sheffield, Wellcome Trust and UK Biobank; and receiving nonfinancial support from Roche. Please see the full study for a list of all other authors’ relevant financial disclosures.