Risk factors for and risk of all-cause and atherosclerotic cardiovascular disease mortality in people with type 2 diabetes and peripheral artery disease: an observational, register-based cohort study
Abstract Background Type 2 diabetes (T2D) and peripheral artery disease (PAD) are recognized as independent risk factors contributing to excess mortality. Contemporary observational studies exploring the associations of risk factors, and risk of all-cause and atherosclerotic cardiovascular disease m...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-04-01
|
| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-024-02226-x |
| _version_ | 1797199690562797568 |
|---|---|
| author | Tarik Avdic Hanne K. Carlsen Aidin Rawshani Soffia Gudbjörnsdottir Zacharias Mandalenakis Björn Eliasson |
| author_facet | Tarik Avdic Hanne K. Carlsen Aidin Rawshani Soffia Gudbjörnsdottir Zacharias Mandalenakis Björn Eliasson |
| author_sort | Tarik Avdic |
| collection | DOAJ |
| description | Abstract Background Type 2 diabetes (T2D) and peripheral artery disease (PAD) are recognized as independent risk factors contributing to excess mortality. Contemporary observational studies exploring the associations of risk factors, and risk of all-cause and atherosclerotic cardiovascular disease mortality in persons with T2D following the onset of incident peripheral artery disease are limited. The objectives of this study were to investigate the associations of risk factors, and assess mortality risks in people with T2D compared with controls without T2D after the onset of PAD. Methods All persons with T2D (n = 150,215) registered in the Swedish National Diabetes Register between 2005 and 2009 were included, along with 346,423 controls without T2D matched for sex and age. Data were retrieved from several national registries, capturing information on risk factors, onset of incident peripheral artery disease, other comorbidities, socioeconomic factors, and outcomes. To compare persons with T2D and controls following the onset of peripheral artery disease regarding the risk of all-cause, and atherosclerotic cardiovascular disease mortality, Cox proportional hazard models and Kaplan-Meier curves were employed. A gradient-boosting model was utilized to estimate the relative statistical contribution of risk factors to the modeling of incident mortality risk in people with both T2D and peripheral artery disease. Results Crude rates of incident all-cause mortality were higher in individuals with T2D compared with controls, following the onset of PAD (600.4 (95% CI, 581.4-619.8) per 10,000 person-years versus 549.1 (95% CI, 532.1-566.5) per 10,000 person-years). Persons with T2D had an adjusted hazard ratio (HR) for all-cause mortality of 1.12 (95% CI, 1.05–1.19, P < 0.01) compared with controls after onset of incident PAD. The comparable adjusted HR for cardiovascular mortality was 1.13 (95% CI, 1.07–1.19, P < 0.01). High age and hyperglycemia at baseline played a significant role in contributing to the predictive models for incident all-cause and cardiovascular mortality among individuals with both T2D and PAD. Conclusions The presence of T2D with concomitant PAD is related to an increased risk of both all-cause and cardiovascular mortality compared with individuals with only PAD. This argues for implementing optimized and intensive treatment strategies for individuals with both conditions. |
| first_indexed | 2024-04-24T07:19:46Z |
| format | Article |
| id | doaj.art-a6bffb90dba345649c881d92621481e2 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-04-24T07:19:46Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-a6bffb90dba345649c881d92621481e22024-04-21T11:07:53ZengBMCCardiovascular Diabetology1475-28402024-04-0123111110.1186/s12933-024-02226-xRisk factors for and risk of all-cause and atherosclerotic cardiovascular disease mortality in people with type 2 diabetes and peripheral artery disease: an observational, register-based cohort studyTarik Avdic0Hanne K. Carlsen1Aidin Rawshani2Soffia Gudbjörnsdottir3Zacharias Mandalenakis4Björn Eliasson5Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of GothenburgSwedish National Diabetes Register, Center of Registers in RegionDepartment of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of GothenburgDepartment of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of GothenburgDepartment of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of GothenburgSwedish National Diabetes Register, Center of Registers in RegionAbstract Background Type 2 diabetes (T2D) and peripheral artery disease (PAD) are recognized as independent risk factors contributing to excess mortality. Contemporary observational studies exploring the associations of risk factors, and risk of all-cause and atherosclerotic cardiovascular disease mortality in persons with T2D following the onset of incident peripheral artery disease are limited. The objectives of this study were to investigate the associations of risk factors, and assess mortality risks in people with T2D compared with controls without T2D after the onset of PAD. Methods All persons with T2D (n = 150,215) registered in the Swedish National Diabetes Register between 2005 and 2009 were included, along with 346,423 controls without T2D matched for sex and age. Data were retrieved from several national registries, capturing information on risk factors, onset of incident peripheral artery disease, other comorbidities, socioeconomic factors, and outcomes. To compare persons with T2D and controls following the onset of peripheral artery disease regarding the risk of all-cause, and atherosclerotic cardiovascular disease mortality, Cox proportional hazard models and Kaplan-Meier curves were employed. A gradient-boosting model was utilized to estimate the relative statistical contribution of risk factors to the modeling of incident mortality risk in people with both T2D and peripheral artery disease. Results Crude rates of incident all-cause mortality were higher in individuals with T2D compared with controls, following the onset of PAD (600.4 (95% CI, 581.4-619.8) per 10,000 person-years versus 549.1 (95% CI, 532.1-566.5) per 10,000 person-years). Persons with T2D had an adjusted hazard ratio (HR) for all-cause mortality of 1.12 (95% CI, 1.05–1.19, P < 0.01) compared with controls after onset of incident PAD. The comparable adjusted HR for cardiovascular mortality was 1.13 (95% CI, 1.07–1.19, P < 0.01). High age and hyperglycemia at baseline played a significant role in contributing to the predictive models for incident all-cause and cardiovascular mortality among individuals with both T2D and PAD. Conclusions The presence of T2D with concomitant PAD is related to an increased risk of both all-cause and cardiovascular mortality compared with individuals with only PAD. This argues for implementing optimized and intensive treatment strategies for individuals with both conditions.https://doi.org/10.1186/s12933-024-02226-xAll-cause mortalityCardiovascular mortalityPeripheral artery diseaseType 2 diabetes mellitusCardiovascular risk factorsCohort study |
| spellingShingle | Tarik Avdic Hanne K. Carlsen Aidin Rawshani Soffia Gudbjörnsdottir Zacharias Mandalenakis Björn Eliasson Risk factors for and risk of all-cause and atherosclerotic cardiovascular disease mortality in people with type 2 diabetes and peripheral artery disease: an observational, register-based cohort study Cardiovascular Diabetology All-cause mortality Cardiovascular mortality Peripheral artery disease Type 2 diabetes mellitus Cardiovascular risk factors Cohort study |
| title | Risk factors for and risk of all-cause and atherosclerotic cardiovascular disease mortality in people with type 2 diabetes and peripheral artery disease: an observational, register-based cohort study |
| title_full | Risk factors for and risk of all-cause and atherosclerotic cardiovascular disease mortality in people with type 2 diabetes and peripheral artery disease: an observational, register-based cohort study |
| title_fullStr | Risk factors for and risk of all-cause and atherosclerotic cardiovascular disease mortality in people with type 2 diabetes and peripheral artery disease: an observational, register-based cohort study |
| title_full_unstemmed | Risk factors for and risk of all-cause and atherosclerotic cardiovascular disease mortality in people with type 2 diabetes and peripheral artery disease: an observational, register-based cohort study |
| title_short | Risk factors for and risk of all-cause and atherosclerotic cardiovascular disease mortality in people with type 2 diabetes and peripheral artery disease: an observational, register-based cohort study |
| title_sort | risk factors for and risk of all cause and atherosclerotic cardiovascular disease mortality in people with type 2 diabetes and peripheral artery disease an observational register based cohort study |
| topic | All-cause mortality Cardiovascular mortality Peripheral artery disease Type 2 diabetes mellitus Cardiovascular risk factors Cohort study |
| url | https://doi.org/10.1186/s12933-024-02226-x |
| work_keys_str_mv | AT tarikavdic riskfactorsforandriskofallcauseandatheroscleroticcardiovasculardiseasemortalityinpeoplewithtype2diabetesandperipheralarterydiseaseanobservationalregisterbasedcohortstudy AT hannekcarlsen riskfactorsforandriskofallcauseandatheroscleroticcardiovasculardiseasemortalityinpeoplewithtype2diabetesandperipheralarterydiseaseanobservationalregisterbasedcohortstudy AT aidinrawshani riskfactorsforandriskofallcauseandatheroscleroticcardiovasculardiseasemortalityinpeoplewithtype2diabetesandperipheralarterydiseaseanobservationalregisterbasedcohortstudy AT soffiagudbjornsdottir riskfactorsforandriskofallcauseandatheroscleroticcardiovasculardiseasemortalityinpeoplewithtype2diabetesandperipheralarterydiseaseanobservationalregisterbasedcohortstudy AT zachariasmandalenakis riskfactorsforandriskofallcauseandatheroscleroticcardiovasculardiseasemortalityinpeoplewithtype2diabetesandperipheralarterydiseaseanobservationalregisterbasedcohortstudy AT bjorneliasson riskfactorsforandriskofallcauseandatheroscleroticcardiovasculardiseasemortalityinpeoplewithtype2diabetesandperipheralarterydiseaseanobservationalregisterbasedcohortstudy |