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- Rawshani, Araz,1986Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine (författare)
Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study
- Artikel/kapitelEngelska2018
Förlag, utgivningsår, omfång ...
- Elsevier BV,2018
Nummerbeteckningar
- LIBRIS-ID:oai:gup.ub.gu.se/270341
- https://gup.ub.gu.se/publication/270341URI
- https://doi.org/10.1016/s0140-6736(18)31506-xDOI
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- Språk:engelska
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- Background People with type 1 diabetes are at elevated risk of mortality and cardiovascular disease, yet current guidelines do not consider age of onset as an important risk stratifier. We aimed to examine how age at diagnosis of type 1 diabetes relates to excess mortality and cardiovascular risk. Methods We did a nationwide, register-based cohort study of individuals with type 1 diabetes in the Swedish National Diabetes Register and matched controls from the general population. We included patients with at least one registration between Jan 1, 1998, and Dec 31, 2012. Using Cox regression, and with adjustment for diabetes duration, we estimated the excess risk of all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, acute myocardial infarction, stroke, cardiovascular disease (a composite of acute myocardial infarction and stroke), coronary heart disease, heart failure, and atrial fibrillation. Individuals with type 1 diabetes were categorised into five groups, according to age at diagnosis: 0-10 years, 11-15 years, 16-20 years, 21-25 years, and 26-30 years. Findings 27 195 individuals with type 1 diabetes and 135 178 matched controls were selected for this study. 959 individuals with type 1 diabetes and 1501 controls died during follow-up (median follow-up was 10 years). Patients who developed type 1 diabetes at 0-10 years of age had hazard ratios of 4.11 (95% CI 3.24-5.22) for all-cause mortality, 7.38 (3.65-14.94) for cardiovascular mortality, 3.96 (3.06-5.11) for non-cardiovascular mortality, 11.44 (7.95-16.44) for cardiovascular disease, 30.50 (19.98-46.57) for coronary heart disease, 30.95 (17.59-54.45) for acute myocardial infarction, 6.45 (4.04-10.31) for stroke, 12.90 (7.39-22.51) for heart failure, and 1.17 (0.62-2.20) for atrial fibrillation. Corresponding hazard ratios for individuals who developed type 1 diabetes aged 26-30 years were 2.83 (95% CI 2.38-3.37) for all-cause mortality, 3.64 (2.34-5.66) for cardiovascular mortality, 2.78 (2.29-3.38) for non-cardiovascular mortality, 3.85 (3.05-4.87) for cardiovascular disease, 6.08 (4.71-7.84) for coronary heart disease, 5.77 (4.08-8.16) for acute myocardial infarction, 3.22 (2.35-4.42) for stroke, 5.07 (3.55-7.22) for heart failure, and 1.18 (0.79-1.77) for atrial fibrillation; hence the excess risk differed by up to five times across the diagnosis age groups. The highest overall incidence rate, noted for all-cause mortality, was 1.9 (95% CI 1.71-2.11) per 100 000 person-years for people with type 1 diabetes. Development of type 1 diabetes before 10 years of age resulted in a loss of 17.7 life-years (95% CI 14.5-20.4) for women and 14.2 life-years (12.1-18.2) for men. Interpretation Age at onset of type 1 diabetes is an important determinant of survival, as well as all cardiovascular outcomes, with highest excess risk in women. Greater focus on cardioprotection might be warranted in people with early-onset type 1 diabetes. Funding Swedish Heart and Lung Foundation. Copyright (c) 2018 Elsevier Ltd. All rights reserved.
Ämnesord och genrebeteckningar
- MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Endokrinologi och diabetes hsv//swe
- MEDICAL AND HEALTH SCIENCES Clinical Medicine Endocrinology and Diabetes hsv//eng
- MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
- MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
- American-Heart-Association
- glycemic control
- endothelial dysfunction
- scientific statement
- general-population
- lowering therapy
- mellitus
- children
- individuals
- thickness
Biuppslag (personer, institutioner, konferenser, titlar ...)
- Sattar, N. (författare)
- Franzen, S. (författare)
- Rawshani, A. (författare)
- Hattersley, A. T. (författare)
- Svensson, A. M. (författare)
- Eliasson, Björn,1959Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition(Swepub:gu)xelibj (författare)
- Gudbjornsdottir, S. (författare)
- Göteborgs universitetInstitutionen för medicin, avdelningen för molekylär och klinisk medicin (creator_code:org_t)
Sammanhörande titlar
- Ingår i:The Lancet: Elsevier BV392:10146, s. 477-4860140-6736
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