Dissimilar Impact of Type 2 Diabetes on Cardiovascular Outcomes According to Age Categories: a Nationwide Population Study from Hungary

Overview

Journal Cardiovasc Diabetol

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
Endocrinology

Date 2018 Jul 29

PMID 30053870

Citations 7

Authors

Zoltan Kiss

Gyorgy Rokszin

Zsolt Abonyi-Toth

Gyorgy Jermendy

Peter Kempler

Daniel Aradi

Istvan Wittmann

Affiliations

Soon will be listed here.

Abstract

Background: The excess risks of mortality and cardiovascular morbidity among patients with type 2 diabetes mellitus (T2DM) is well known. In this nationwide study, we assessed risks of mortality and cardiovascular events comparing patients with T2DM and matched controls.

Methods: We identified patients with T2DM in a retrospective cohort study using the database of the National Health Insurance Fund between 1 January 2010 and 31 December, 2013. Controls were randomly included and matched according to age, gender, and zip code of residence. Patients were divided into subgroups according to age decades for outcome analyses.

Results: During the mean follow-up period of 2.3 years, 152,678 patients with T2DM and 305,356 matched controls were included. Patients with T2DM showed significantly higher risk for all-cause mortality (HR 1.26, 95% CI 1.22-1.29, p < 0.0001), myocardial infarction (HR 1.81, 95% CI 1.69-1.94, p < 0.0001) and stroke (HR 1.40, 95% CI 1.35-1.46, p < 0.0001) compared to matched controls. The higher risk associated with T2DM for mortality, myocardial infarction and stroke differed significantly between age groups (p < 0.05 for all outcomes) with significantly higher risk observed in younger patients.

Conclusions: The risk of cardiovascular outcomes and all-cause mortality is significantly higher in patients with T2DM. Notably, the relative hazard increases with decreasing age suggesting that younger patients with T2DM should receive more attention for cardiovascular prevention.

Citing Articles

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Incidence of Stroke in People With Diabetes Compared to Those Without Diabetes: A Systematic Review.

Kvitkina T, Narres M, Claessen H, Metzendorf M, Richter B, Icks A Exp Clin Endocrinol Diabetes. 2023; 131(9):476-490.

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Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review.

Bosco E, Hsueh L, McConeghy K, Gravenstein S, Saade E BMC Med Res Methodol. 2021; 21(1):241.

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Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study.

Suto G, Molnar G, Rokszin G, Fabian I, Kiss Z, Szekanecz Z BMJ Open Diabetes Res Care. 2021; 9(1).

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Risk of early mortality and cardiovascular disease in type 1 diabetes: a comparison with type 2 diabetes, a nationwide study.

Lee Y, Han K, Kim B, Lee S, Jun J, Ahn J Cardiovasc Diabetol. 2019; 18(1):157.

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References

Natarajan S, Liao Y, Cao G, Lipsitz S, McGee D . Sex differences in risk for coronary heart disease mortality associated with diabetes and established coronary heart disease. Arch Intern Med. 2003; 163(14):1735-40. DOI: 10.1001/archinte.163.14.1735. View

Wang M, Lin S, Tang P, Hung W, Cheng C, Yang J . The impact of DPP-4 inhibitors on long-term survival among diabetic patients after first acute myocardial infarction. Cardiovasc Diabetol. 2017; 16(1):89. PMC: 5505012. DOI: 10.1186/s12933-017-0572-0. View

Mehta S, Ghosh S, Sander S, Kuti E, Mountford W . Differences in All-Cause Health Care Utilization and Costs in a Type 2 Diabetes Mellitus Population with and Without a History of Cardiovascular Disease. J Manag Care Spec Pharm. 2018; 24(3):280-290. PMC: 10397852. DOI: 10.18553/jmcp.2018.24.3.280. View

Mahaffey K, Neal B, Perkovic V, de Zeeuw D, Fulcher G, Erondu N . Canagliflozin for Primary and Secondary Prevention of Cardiovascular Events: Results From the CANVAS Program (Canagliflozin Cardiovascular Assessment Study). Circulation. 2017; 137(4):323-334. PMC: 5777572. DOI: 10.1161/CIRCULATIONAHA.117.032038. View

Kiss Z, Nagy L, Reiber I, Paragh G, Molnar M, Rokszin G . Persistence with statin therapy in Hungary. Arch Med Sci. 2013; 9(3):409-17. PMC: 3701976. DOI: 10.5114/aoms.2013.35327. View

van Herpt T, Dehghan A, van Hoek M, Ikram M, Hofman A, Sijbrands E . The clinical value of metabolic syndrome and risks of cardiometabolic events and mortality in the elderly: the Rotterdam study. Cardiovasc Diabetol. 2016; 15:69. PMC: 4847340. DOI: 10.1186/s12933-016-0387-4. View

Beckman J, Paneni F, Cosentino F, Creager M . Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part II. Eur Heart J. 2013; 34(31):2444-52. DOI: 10.1093/eurheartj/eht142. View

Jermendy G, Kempler P, Abonyi-Toth Z, Rokszin G, Wittmann I . [Changes in features of diabetes care in Hungary in the period of years 2001-2014. Aims and methods of the database analysis of the National Health Insurance Fund]. Orv Hetil. 2016; 157(32):1259-65. DOI: 10.1556/650.2016.30519. View

Bohn B, Schofl C, Zimmer V, Hummel M, Heise N, Siegel E . Achievement of treatment goals for secondary prevention of myocardial infarction or stroke in 29,325 patients with type 2 diabetes: a German/Austrian DPV-multicenter analysis. Cardiovasc Diabetol. 2016; 15:72. PMC: 4855873. DOI: 10.1186/s12933-016-0391-8. View

10.

Deconinck B, Mathieu C, Benhalima K . Characteristics and cardiovascular complications of a large cohort of adults diagnosed with type 2 diabetes <45 years. Diabetol Metab Syndr. 2017; 9:28. PMC: 5414117. DOI: 10.1186/s13098-017-0227-z. View

11.

Szocs I, Bereczki D, Belicza E . [Results of stroke care in Hungary in the frame of international comparison]. Orv Hetil. 2016; 157(41):1635-1641. DOI: 10.1556/650.2016.30558. View

12.

Seshasai S, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, Sarwar N . Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011; 364(9):829-841. PMC: 4109980. DOI: 10.1056/NEJMoa1008862. View

13.

Hothorn T, Bretz F, Westfall P . Simultaneous inference in general parametric models. Biom J. 2008; 50(3):346-63. DOI: 10.1002/bimj.200810425. View

14.

Muskiet M, van Raalte D, van Bommel E, van Bommel E, Smits M, Tonneijck L . Understanding EMPA-REG OUTCOME. Lancet Diabetes Endocrinol. 2015; 3(12):928-9. DOI: 10.1016/S2213-8587(15)00424-6. View

15.

Tancredi M, Rosengren A, Svensson A, Kosiborod M, Pivodic A, Gudbjornsdottir S . Excess Mortality among Persons with Type 2 Diabetes. N Engl J Med. 2015; 373(18):1720-32. DOI: 10.1056/NEJMoa1504347. View

16.

Muller N, Khunti K, Kuss O, Lindblad U, Nolan J, Rutten G . Is there evidence of potential overtreatment of glycaemia in elderly people with type 2 diabetes? Data from the GUIDANCE study. Acta Diabetol. 2016; 54(2):209-214. DOI: 10.1007/s00592-016-0939-9. View

17.

Evans M, Kozlovski P, Paldanius P, Foley J, Bhosekar V, Serban C . Factors that may Account for Cardiovascular Risk Reduction with a Dipeptidyl Peptidase-4 Inhibitor, Vildagliptin, in Young Patients with Type 2 Diabetes Mellitus. Diabetes Ther. 2017; 9(1):27-36. PMC: 5801217. DOI: 10.1007/s13300-017-0329-5. View

18.

Gulliford M, Charlton J . Is relative mortality of type 2 diabetes mellitus decreasing?. Am J Epidemiol. 2008; 169(4):455-61. DOI: 10.1093/aje/kwn342. View

19.

Li M, Zhao C, Li T, Tu Y, Lu J, Zhang R . The coexistence of carotid and lower extremity atherosclerosis further increases cardio-cerebrovascular risk in type 2 diabetes. Cardiovasc Diabetol. 2016; 15:43. PMC: 4779218. DOI: 10.1186/s12933-016-0360-2. View

20.

Ueki K, Sasako T, Okazaki Y, Kato M, Okahata S, Katsuyama H . Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial. Lancet Diabetes Endocrinol. 2017; 5(12):951-964. DOI: 10.1016/S2213-8587(17)30327-3. View