Abstract
Background: To analyze all-cause mortality and cardiovascular events in nonagenarians from a Mediterranean population.Methods: Primary Health Care (265 health centres)Participants: Primary health records of all the nonagenarians living in the Community of Madrid (N=59,423). We defined 4 groups according to prevalent type 2 diabetes mellitus and established cardiovascular disease: (1) type 2 diabetes mellitus (-), cardiovascular disease (-); (2) type 2 diabetes mellitus (-), cardiovascular disease (+); (3) type 2 diabetes mellitus (+), cardiovascular disease (-); and (4) type 2 diabetes mellitus (+), cardiovascular disease (+). Follow-up time was 2.5 years. Primary outcome: Cumulative incidence and the density incidence rates of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke (combined they constituted the first composite primary outcome (CPO1)), and heart failure (similarly, combined with the previous they constituted CPO2). We evaluated the adjusted effect of groups classification on all-cause mortality (Cox regression). Results. Mean age was 93.3±2.8 years; 74.2% were women. Hypertension, dyslipidemia, heart failure, albuminuria and estimated glomerular filtration rate <60 mL/min/1.73m2 were significantly more prevalent in group 4 (type 2 diabetes mellitus (+), cardiovascular disease (+)) than in the other groups (all p values <0.001). We observed significantly higher rates of cumulative incidence of all-cause mortality, CPO1 and CPO2 in participants belonging to group 4 (all p values ≤0.001). People in group 2 (type 2 diabetes mellitus (-), cardiovascular disease (+)) presented higher rates of all-cause mortality, heart failure, CPO1 and CPO2 than people in group 3 (type 2 diabetes mellitus (+), cardiovascular disease (-)) (all p values ≤0.001). In the fully-adjusted model, prevalent type 2 diabetes mellitus plus established cardiovascular disease (group 4) independently predicted all-cause mortality (HR=1.48 (95% CI, 1.40 to 1.57) as compared to reference group 1 (type 2 diabetes mellitus (-), cardiovascular disease (-)) (p <0.01). Also, cardiovascular disease and type 2 diabetes mellitus alone showed significant HRs (1.13 and 1.14, respectively; both p values <0.01)).Conclusions. In Spanish nonagenarians, established cardiovascular disease and type 2 diabetes mellitus conferred modest all-cause mortality risks. The concurrent presence of both conditions conferred the highest all-cause mortality risk.
All-Cause Mortality And Cardiovascular Events In A Spanish Nonagenarian Cohort According To Type 2 Diabetes Mellitus Status And Established Cardiovascular Disease