| 1. |
- Jansson, Stefan P. O., 1959-, et al.
(author)
-
Effects of fasting blood glucose levels and blood pressure and treatment of diabetes and hypertension on the incidence of cardiovascular disease : a study of 740 patients with incident Type 2 diabetes with up to 30 years' follow-up
- 2014
-
In: Diabetic Medicine. - : Wiley-Blackwell. - 0742-3071 .- 1464-5491. ; 31:9, s. 1055-1063
-
Journal article (peer-reviewed)abstract
- Aims: To analyse the effects of hyperglycaemia and hypertension and treatment of diabetes and hypertension on cardiovascular disease incidence in patients with Type 2 diabetes with up to 30 years of follow-up.Methods: A total of 740 patients with incident Type 2 diabetes were registered at the Laxa Primary Health Care Centre, Sweden between 1972 and 2001. Annual data on mean fasting blood glucose, systolic, diastolic and mean arterial blood pressure, and type of diabetes and hypertension treatment were obtained from patient records, and information on cardiovascular disease, myocardial infarction and stroke events was obtained from national registers.Results: During the follow-up period, cumulative cardiovascular disease incidence increased significantly with male sex (hazard ratio 1.48, 95% CI 1.21-1.82), number of previous cardiovascular disease events (hazard ratio 1.13, 95% CI 1.08-1.18), age, per year (HR 1.05, 95% CI 1.04-1.07), mean fasting blood glucose, per mmol/l (hazard ratio 1.05, 95% CI 1.00-1.10) BMI (hazard ratio 1.04, 95% CI 1.01-1.06), mean arterial blood pressure, per mmHg (hazard ratio 1.02, 95% CI 1.01-1.03), and decreased significantly with metformin treatment (hazard ratio 0.58, 95% CI 0.38-0.90) and sulfonylurea (hazard ratio 0.73, 95% CI 0.55-0.97). Cumulative myocardial infarction incidence increased significantly with male sex, number of previous myocardial infarction events, mean fasting blood glucose level, BMI, age and mean arterial blood pressure, and decreased with metformin treatment. Cumulative stroke incidence increased with number of previous stroke events, age and mean arterial blood pressure.Conclusions: The cumulative incidence of cardiovascular disease and myocardial infarction increased with number of previous events and presence of hyperglycaemia and hypertension and decreased with pharmacological treatment of diabetes. A higher number of previous stroke events increased the cumulative incidence of stroke but no protective effect of pharmacological treatment was observed.
|
|
| 2. |
- Jansson, Stefan P.O. 1959-
(author)
-
A Longitudinal Study of Diabetes Mellitus : With Special Reference to Incidence and Prevalence, and to Determinants of Macrovascular Complications and Mortality
- 2014
-
Doctoral thesis (other academic/artistic)abstract
- Objectives. To investigate diabetes prevalence, incidence, mortality trends, the effects of hyperglycaemia and blood pressure, diabetes and hypertension treatment, and the effect of screening detection on total and cardiovascular disease (CVD), myocardial infarction (MI) and stroke incidence.Study population and methods. Between 1972 and 2001 all patients with diabetes, some detected clinically and some by case-finding procedures (screening), were entered in a diabetes register at Laxå Primary Health Care Center in Sweden. The register included information on medical treatment and laboratory data as well as information on mortality and morbidity from National Registers. The register was supplemented with five non-diabetic subjects, matched to each diabetes patients by age, sex, and year of detection.Results. During the study period 776 new diabetes cases was found, 36 type 1 diabetes mellitus and 740 type 2 diabetes mellitus. Age standardised incidence and prevalence rates for type 1 and type 2 diabetes did not increase over time. Diabetic patients had 17% higher mortality rate than non-diabetic persons, 22% in women and 13% in men. The corresponding over-mortality in CVD was 33%, 41% in women and 27% in men. CVD mortality decreased across time in non-diabetic subjects and in diabetic men but not in diabetic women. Results regarding coronary heart disease (CHD) were similar. CVD incidence increased with fasting blood glucose (FBG), body mass index (BMI), mean arterial blood pressure (MABP), and decreased with metformin treatment and sulfonylurea. Myocardial infarction incidence increased with FBG, BMI and MABP, and decreased with metformin treatment. Stroke incidence increased with MABP. There was no difference in prognoses between those detected by screening or clinically.Conclusions. Diabetes prevalence and incidence did not change over time. The over-mortality according to diabetes was moderate. CVD and MI during follow up were negatively affected by hypertension and hyperglycaemia, and positively by pharmacological diabetic treatment. For stroke no pharmacological protective effect was seen. Screening did not improve prognosis.
|
|
| 3. |
- Jansson, Stefan P.O. 1959-, et al.
(author)
-
Effects of fasting blood glucose, diabetes treatment, blood pressure, and hypertension treatment on cardiovascular disease incidence : A 30-year follow-up study of 740 incident patients with type 2 diabetes
-
In: Diabetic Medicine. - 0742-3071 .- 1464-5491.
-
Journal article (peer-reviewed)abstract
- Aims: To analyse the effects of hyperglycaemia and blood pressure, diabetes and hypertension treatment on total and various types of cardiovascular disease (CVD) incidence in patients with type 2 diabetes followed for 30 years.Methods: 740 incident patients with type 2 diabetes were registered at the Laxå Primary Health Care Centre, Sweden between 1972 and 2001. Annual information on systolic, diastolic, and mean arterial blood pressure (MABP), mean fasting blood glucose (FBG), type of diabetes and hypertension treatment was obtained from the patient records, and information on CVD, myocardial infarction (MI), and stroke events from National Registers.Results: During the follow-up period cumulative CVD incidence increased significantly with male sex (HR 1.48, 95% CI 1.21-1.82), number of previous CVD events (HR 1.13, 95% CI 1.08-1.18) age (HR 1.05, 95% CI 1.04-1.07), mean FBG (HR 1.05, 96% CI 1.00-1.10) BMI, (HR 1.04, 95% CI 1.01-1.06), MABP (HR 1.02, 95% CI 1.01-1.03), and decreased significantly with metformin treatment (HR 0.58, 95% CI 0.38-0.90) and sulfonylurea (HR 0.73, 95% CI 0.55-0.97). Cumulative MI incidence increased significantly with male sex, number of previous MI events, mean FBG, BMI, age, and MABP, and decreased with metformin treatment. Cumulative stroke incidence increased with previous number of stroke events, age, and MABP.Conclusions: Cumulative CVD and MI incidence increased with number of previous events and presence of hypertension and hyperglycaemia and decreased with pharmacological diabetic treatment. For stroke, previous number of events increased the incidence but no pharmacological protective effect was seen.
|
|
| 4. |
- Jansson, Stefan P.O. 1959-, et al.
(author)
-
Mortality and cardiovascular outcomes in patients detected by screening or clinically diagnosed type 2 diabetes. : A 30-year follow-up study of 740 incident patients with type 2 diabetes
-
In: Diabetes Care. - 0149-5992 .- 1935-5548.
-
Journal article (peer-reviewed)abstract
- Objective Screening for type 2 diabetes among high-risk subjects is recommended by many organizations. The aim of this study was to analyse all-cause mortality and cardiovascular disease (CVD) outcomes in type 2 diabetes subjects detected by screening and those clinically diagnosed during 30 years of follow-up.Research design and methods A diabetes register was established at the primary healthcare centre (PHCC) in Laxå, beginning in 1972 and based on data from clinical records with information on medical treatment and laboratory data as well as information on all-cause mortality, CVD, myocardial infarction (MI), and stroke events from National Registers. A total of 740 incident patients with type 2 diabetes were registered between 1972- 2001. In addition, case-finding procedures involving 85% of residents aged 35 to 79 were performed from 1983 onwards.ResultsBaseline characteristics showed a significantly higher CVD risk, mainly depending on more prevalent CVD events in the screened as compared with the clinically detected group (propensity score 0.59 vs. 0.46, p<0.0001). After a mean follow-up of 10 and 11.5 years for screening detected and clinically detected subjects respectively, HRs incidences were for all-cause mortality 1.01 (p=0.97), CVD 1.00 (p=0.99), and MI 1.03 (p=0.87). For stroke a 24% non-significant lower risk for screening detected as compared with clinically detected subjects were found, HR 0.76 (p=0.15).Conclusions No reduction in total mortality and CVD outcomes was found in type 2 diabetes subjects detected by screening as compared with those clinically diagnosed, even though stroke incidence tended to be lower.
|
|
| 5. |
|
|
