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Original research article
Glycaemic control and excess risk of major coronary events in persons with type 1 diabetes
  1. Viktorija Matuleviciene-Anängen1,
  2. Annika Rosengren1,
  3. Ann-Marie Svensson2,
  4. Aldina Pivodic3,
  5. Soffia Gudbjörnsdottir1,
  6. Hans Wedel8,
  7. Mikhail Kosiborod4,
  8. Börje Haraldsson1,
  9. Marcus Lind1,5
  1. 1 Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
  2. 2 Center of Registers in Region Västra Götaland, Gothenburg, Sweden
  3. 3 Statistiska Konsultgruppen, Gothenburg, Sweden
  4. 4 Saint Luke’s Mid America Heart Institute and University of Missouri, Kansas City, Missouri, USA
  5. 5 Department of Medicine, NU Hospital Organization, Uddevalla, Sweden
  6. 8 Health Metrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  1. Correspondence to Viktorija Matuleviciene-Anängen, Karolinska University Hospital, Karolinska road, 171 76 Solna, Sweden; viktorija.matuleviciene-anangen{at}karolinska.se

Abstract

Objective The excess risk of major coronary events (acute myocardial infarction (AMI) or death from coronary heart disease (CHD)) in individuals with type 1 diabetes (T1D) in relation to glycaemic control and renal complications is not known.

Methods Individuals with T1D in the Swedish National Diabetes Registry after 1 January 1998, without a previous MI (n=33 170) and 1 64 698 controls matched on age, sex and county were followed with respect to non-fatal AMI or death from CHD. Data were censored at death due to any cause until 31 December 2011.

Results During median follow-up of 8.3 and 8.9 years for individuals with T1D and controls, respectively, 1500 (4.5%) and 1925 (1.2%), experienced non-fatal AMI or died from CHD, adjusted HR 4.07 (95% CI 3.79 to 4.36). This excess risk increased with younger age, female sex, worse glycaemic control and severity of renal complications.

The adjusted HR in men with T1D with updated mean haemoglobin A1c (HbA1c) <6.9% (52 mmol/mol) and normoalbuminuria was 1.30 (95% CI 0.90 to 1.88) and in women 3.16 (95% CI 2.14 to 4.65). HRs increased to 10.7 (95% CI 8.0 to 14.3) and 31.8 (95% CI 23.6 to 42.8) in men and women, respectively, with HbA1c >9.7% and renal complications.

Conclusions The excess risk of AMI in T1D is substantially lower with good glycaemic control, absence of renal complications and men compared with women. In women, the excess risk of AMI or CHD death persists even among patients with good glycaemic control and no renal complications.

  • diabetes mellitus
  • type1
  • blood glucose
  • myocardial infarction
  • coronary disease
  • diabetes complications

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Footnotes

  • Contributors All authors (VM-A, AR, A-MS, AP, SG, HW, MK, BH, ML) contributed extensively to the work presented in this paper, discussed the conception and design of the study, interpretation of data and commented on the manuscript at all stages.

  • Competing interests ML reports receiving honoraria or been consultant for AstraZeneca, Eli Lilly, Medtronic, Novo Nordisk and Pfizer and grant support from AstraZeneca, Dexcom, Novo Nordisk and Pfizer. All other authors declare no conflicts of interest.

  • Ethics approval Ethical committee at the University of Gothenburg, Gothenburg, Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data supporting this study are provided as supplementary information accompanying this paper.

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