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Declines in CV events, mortality comparable between adults with diabetes, general population
Mortality and incidence of cardiovascular outcomes decreased in Sweden from 1998 to 2014 in adults with diabetes. Although rates of nonfatal cardiovascular events dropped further for those with diabetes than those for the general population, the absolute rates remain higher for adults with either type 1 or type 2 diabetes, according to study findings published in The New England Journal of Medicine.
Adin Rawshani, MD, of the department of molecular and clinical medicine, Institute of Medicine at the University of Gothenburg, and colleagues evaluated data from the Swedish National Diabetes Register from 1998 to 2012 on 36,869 adults with type 1 diabetes (mean age at entry, 35.3 years; mean HbA1c, 8.2%) and 457,473 adults with type 2 diabetes (mean age at entry, 65.2 years; mean HbA1c, 7.1%) along with matched controls for each diabetes group to determine the long-term trends in all-cause mortality and the incidence of major diabetes-related CV complications. Follow-up was a mean 11.2 years in the type 1 diabetes group and 6.5 years in the type 2 diabetes group.
From 1998 to 2014, the mortality rate declined by 29% in the type 1 diabetes group compared with 23% in controls, revealing no significant difference in mortality rate change between participants with type 1 diabetes and controls (HR = 1.08; 95% CI, 0.99-1.18). However, the all-cause mortality rate declined by 21% in those with type 2 diabetes vs. 31% in controls (HR = 0.87; 95% CI, 0.85-0.89).
There was a 42% relative event-rate reduction for CVD death among the type 1 diabetes group compared with a 38% decline in controls (HR = 1.06; 95% CI, 0.89-1.26). Among those with type 2 diabetes, the relative event-rate reduction for CVD death was 46% vs. 50% among controls (HR = 0.94; 95% CI, 0.9-0.98). No significant difference was found between controls and the type 1 diabetes group for death from coronary heart disease whereas there was a 6% greater reduction among controls compared with the type 2 diabetes group (P = .009).
The event rate reduction for hospitalization for CVD was higher among the type 2 diabetes group (44%) compared with the type 1 diabetes group (36%). The reduction in rate of hospitalization for heart failure was 18% greater in the type 2 diabetes group compared with controls (HR = 1.18; 95% CI, 1.12-1.23) whereas there was no difference between controls and the type 1 diabetes group.
“We report a decline in all-cause mortality and the incidence of CV complications among patients with type 1 diabetes or type 2 diabetes in the Swedish [National Diabetes Register],” the researchers wrote. “The reduction in fatal outcomes did not differ significantly between patients with type 1 diabetes and controls, and the reduction in such outcomes was smaller among patients with type 2 diabetes than among controls. Nonfatal outcomes decreased more rapidly among patients with either type of diabetes than among controls, but the event rates of all outcomes studied remained significantly higher among patients with diabetes.” – by Amber Cox
Disclosure: Rawshani reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.