Risk differences and underlying factors of cardiovascular events and mortality in patients with type 2 diabetes versus type 1 diabetes: a longitudinal cohort study of Swedish nationwide register data
Authors' conclusion
In this study, type 1 diabetes was associated with higher overall risk for cardiovascular disease events and all-cause mortality than type 2 diabetes, particularly at ages older than 60 years for the studied outcomes. Longer diabetes duration seems to be a main contributing factor for higher risk found in people with type 1 diabetes versus those with type 2 diabetes in this age group. Enhanced management of all modifiable risk factors could help prevent cardiovascular disease and premature death in both type 1 and type 2 diabetes.
Study context
- Population
- All living adults with diabetes aged 18–84 years in the Swedish National Diabetes Register by Jan 1, 2016, followed up until Dec 31, 2020
- Participants
- 404,026 participants
- Exposure
- T2D vs T1D
- T2Dn = 365,675
- T1Dn = 38,351reference
- Outcome
- Composite of any major CVD event (MI, HF onset or exacerbation, stroke, cardiovascular death)
- Follow-up
- 5 years
Methodological detailsnationwide, longitudinal, register-based, Cox regression adjusted for age and sex and for multiple cardiovascular risk factors, comparison with matched controls without diabetes
- Nationwide
- Longitudinal
- Register-based
- Cox regression adjusted for age and sex and for multiple cardiovascular risk factors
- Comparison with matched controls without diabetes
Main finding
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | HR (CI) | |
|---|---|---|
| MI, ages >60 years | 0.67 (0.61–0.73) | |
| All-cause mortality, ages >60 years | 0.89 (0.84–0.95) | |
| Stroke, all ages | 0.91 (0.84–0.98) | |
| HF, ages <50 years | 1.60 (1.15–2.21) | |
| Previous CVD subgroup: all CVD, MI, cardiovascular mortality, all-cause mortalityT2Dvs T1DAll CVD | 0.76 (0.70–0.81) | |
| Previous CVD subgroup: all CVD, MI, cardiovascular mortality, all-cause mortalityT2Dvs T1DMI | 0.62 (0.56–0.70) | |
| Previous CVD subgroup: all CVD, MI, cardiovascular mortality, all-cause mortalityT2Dvs T1DCardiovascular mortality | 0.68 (0.61–0.75) | |
| Previous CVD subgroup: all CVD, MI, cardiovascular mortality, all-cause mortalityT2Dvs T1DAll-cause mortality | 0.71 (0.66–0.77) | |
| 0.512Hazard ratio (log scale) |
Multivariable-adjusted analyses
- Adjusted for multiple risk factors, T2D had greater risk of incident CVD and mortality vs T1D; with diabetes duration excluded from the model, T1D was associated with higher risk
Vs matched controls without diabetes
- Both diabetes types associated with greater risk for the studied outcomes, most marked for T1D
Original publication
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