Abstract P668: Clinically Meaningful Weight Gain Before Menopause and Risk of Stroke

Background: Obesity is an independent risk factor for stroke. Weight gain has been associated with a higher risk of cardiovascular diseases in postmenopausal women. It is unclear, however, if weight changes before menopause have similar effects. We hypothesized that clinically meaningful premenopausal weight gain, defined as Body Mass Index (BMI) change >5%, would be associated with a higher stroke risk later in life. Methods: Using data from the California Teachers Study, we identified women aged < 55 with no history of stroke. We used weight changes between 1995-2006 as proxy for premenopausal weight gain. We defined weight change as modest or moderate using BMI changes of 5-10% and >10% respectively. Stroke outcomes were obtained from linkage to California hospitalization records. We used Cox regression models to calculate hazard ratios with 95% confidence intervals for the association of weight change and future stroke, adjusting for vascular risk factors. Results: Of 17,295 women included in the study, 113 had a stroke. In comparison to women who maintained a stable weight, women with moderate weight gain during premenopausal years had 2.0 times the risk of stroke. In the adjusted analysis, women with moderate weight gain had 89.6% higher risk of stroke, compared to the reference group. We found no significant association with stroke in women who had modest weight changes. Conclusion: Moderate premenopausal weight gain significantly increased stroke risk in women. Younger women should be educated about the effects of weight gain on future brain health. Count: 1836/1950

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Association Between Weight Change and Leukocyte Telomere Length in U.S. Adults

Frontiers in Endocrinology ◽

10.3389/fendo.2021.650988 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yiling Zhang ◽

Ziye Xu ◽

Yiling Yang ◽

Shanshan Cao ◽

Sali Lyu ◽

...

Keyword(s):

Weight Gain ◽

Telomere Length ◽

Weight Change ◽

Reference Group ◽

Normal Weight ◽

Leukocyte Telomere Length ◽

Weight Changes ◽

Health And Nutrition ◽

Race Ethnicity ◽

Stratified Analysis

ObjectiveTo investigate the association of dynamic weight change in adulthood with leukocyte telomere length among U.S. adults.MethodsThis study included 3,886 subjects aged 36-75 years from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 cycle. Survey-weighted multivariable linear regression with adjustments for potential confounders was utilized.Results3,386 individuals were finally included. People with stable obesity had a 0.130 kbp (95% CI: 0.061-0.198, P=1.97E-04) shorter leukocyte telomere length than those with stable normal weight (reference group) during the 10-year period, corresponding to approximately 8.7 years of aging. Weight gain from non-obesity to obesity shortened the leukocyte telomere length by 0.094 kbp (95% CI: 0.012-0.177, P=0.026), while normal weight to overweight or remaining overweight shortened the leukocyte telomere length by 0.074 kbp (95% CI: 0.014-0.134, P=0.016). The leukocyte telomere length has 0.003 kbp attrition on average for every 1 kg increase in weight from a mean age of 41 years to 51 years. Further stratified analysis showed that the associations generally varied across sex and race/ethnicity.ConclusionsThis study found that weight changes during a 10-year period was associated with leukocyte telomere length and supports the theory that weight gain promotes aging across adulthood.

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A population-wide analysis of the familial risk of suicide in Utah, USA

Psychological Medicine ◽

10.1017/s0033291721003020 ◽

2021 ◽

pp. 1-10

Author(s):

Amanda V. Bakian ◽

Danli Chen ◽

Chong Zhang ◽

Heidi A. Hanson ◽

Anna R. Docherty ◽

...

Keyword(s):

Suicide Risk ◽

Cox Regression ◽

Familial Risk ◽

Risk Groups ◽

Population Based ◽

Unified Framework ◽

Population Database ◽

First Degree Relatives ◽

Hazard Ratios ◽

History Of

Abstract Background The degree to which suicide risk aggregates in US families is unknown. The authors aimed to determine the familial risk of suicide in Utah, and tested whether familial risk varies based on the characteristics of the suicides and their relatives. Methods A population-based sample of 12 160 suicides from 1904 to 2014 were identified from the Utah Population Database and matched 1:5 to controls based on sex and age using at-risk sampling. All first through third- and fifth-degree relatives of suicide probands and controls were identified (N = 13 480 122). The familial risk of suicide was estimated based on hazard ratios (HR) from an unsupervised Cox regression model in a unified framework. Moderation by sex of the proband or relative and age of the proband at time of suicide (<25 v. ⩾25 years) was examined. Results Significantly elevated HRs were observed in first- (HR 3.45; 95% CI 3.12–3.82) through fifth-degree relatives (HR 1.07; 95% CI 1.02–1.12) of suicide probands. Among first-degree relatives of female suicide probands, the HR of suicide was 6.99 (95% CI 3.99–12.25) in mothers, 6.39 in sisters (95% CI 3.78–10.82), and 5.65 (95% CI 3.38–9.44) in daughters. The HR in first-degree relatives of suicide probands under 25 years at death was 4.29 (95% CI 3.49–5.26). Conclusions Elevated familial suicide risk in relatives of female and younger suicide probands suggests that there are unique risk groups to which prevention efforts should be directed – namely suicidal young adults and women with a strong family history of suicide.

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Abstract P051: Lifestyle Change In Mid-life And Long-term Weight Gain In Women With And Without History Of Gestational Diabetes Mellitus

Circulation ◽

10.1161/circ.143.suppl_1.p051 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Jiaxi Yang ◽

Janet Rich-Edwards ◽

Molin Wang ◽

Wafaie W Fawzi ◽

Cuilin Zhang ◽

...

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Body Weight ◽

Weight Gain ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Weight Change ◽

Lifestyle Change ◽

History Of

Introduction: Identifying strategies to mitigate gradual long-term weight gain is critical for preventing obesity and its related chronic diseases, particularly for persons at high risk, such as women with a history of gestational diabetes mellitus (GDM). We prospectively examined the independent associations between lifestyle changes in mid-life with long-term weight change among women with and without a history of GDM. Hypothesis: We hypothesized that favorable improvements in lifestyle would be associated with less long-term weight gain, particularly among women with a history of GDM. Methods: We used data from the longitudinal Nurses’ Health Study II, with self-reported lifestyle, diet via food frequency questionnaire, and body weight updated every 2-4 years. We analyzed repeated 4-year changes of the following lifestyle factors among parous women after age 40: adherence to a healthy dietary pattern (Alternate Healthy Eating Index score [AHEI]), physical activity (MET-hrs/wk), moderate alcohol intake (servings/d), and non-smoking, in relation to concurrent 4-year change in body weight (lb). We used multivariable generalized estimating equation models to estimate the least-squares mean of 4-year weight change and 95% confidence interval (CI) for each lifestyle change category (e.g., decrease, remain stable, and increase). Results: Our analysis included 61,637 women, of which 3,444 (5.6%) had a history of GDM. Mean of repeated 4-year weight change after age 40 was 3.0 lb (SD=14.3). Improving diet was associated with favorable 4-year weight change, particularly among women with a history of GDM vs. without GDM (AHEI score change from low to high: -6.3 lb [CI: -9.3, -3.4] vs. -2.7 lb [CI: -3.2, -2.2], respectively; p-interaction=0.04). Increasing physical activity was associated with weight maintenance for GDM women only (MET-hrs/wk change from low to high: 0.6 lb [95% CI: -0.6, 1.7] vs. 2.0 lb [95% CI: 1.8, 2.2] for GDM vs. non-GDM, respectively; p-interaction=0.01). Reducing alcohol (decreased servings/d: 1.9 lb [95% CI: 1.2, 2.6] and 2.8 lb [95% CI: 2.6, 2.9] for GDM vs. non-GDM, respectively) and smoking cessation (recent quitter: 9.8 lb [95% CI: 7.1, 12.5] and 8.5 lb [95% CI: 8.0, 9.1] for GDM vs. non-GDM, respectively) were associated with similar patterns in weight change for women with and without prior GDM. Further, the joint association of improving both diet and physical activity from low to high was related to -12.3 lb (95% CI: -19.5, -5.0) and -6.1 lb (95% CI: -8.0, -4.2) of weight loss for GDM vs. non-GDM women, respectively. Conclusions: We observed that attainable improvements in diet quality and physical activity were associated with weight gain prevention. These findings support continued efforts to improve lifestyle as a beneficial strategy to prevent long-term weight gain, particularly among women with a history of GDM.

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Abstract P283: Resistance Exercise Reduces the Risk of Developing Excess Body Fat and Abdominal Obesity

Circulation ◽

10.1161/circ.137.suppl_1.p283 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Angelique G Brellenthin ◽

Duck-chul Lee ◽

Xuemei Sui ◽

Steven Blair

Keyword(s):

Resistance Exercise ◽

Aerobic Exercise ◽

Body Fat ◽

Abdominal Obesity ◽

Cox Regression ◽

Physical Activity Guidelines ◽

Specific Effects ◽

Hazard Ratios ◽

History Of ◽

Skinfold Measurements

Introduction: Excess body fat and abdominal obesity have been associated with cardiovascular diseases. While aerobic exercise is often recommended to prevent fat accumulation, less evidence exists detailing the specific effects of resistance exercise, independent of or combined with aerobic exercise, on the development of excess body fat and abdominal obesity. Hypothesis: We hypothesized that resistance exercise would be associated with a lower incidence of developing excess body fat and abdominal obesity. Methods: Participants were 7,685 men and women aged 18 to 89 years (mean age, 46) who received a preventive medical examination during 1987-2005 in the Aerobics Center Longitudinal Study. Participants with a history of myocardial infarction, stroke, cancer, excess body fat, or abdominal obesity at baseline were excluded. Resistance exercise (RE) and meeting the 2008 US Physical Activity Guidelines (RE ≥2 days/week) for RE were determined by self-reported leisure-time exercise. Excess body fat was defined as % body fat (≥25 in men, ≥30 in women) based on underwater weighing or skinfold measurements and abdominal obesity as waist girth (>102 cm in men, >88 cm in women). Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident excess body fat and abdominal obesity by RE levels after adjusting for baseline age, sex, examination year, body weight, current smoking, heavy alcohol drinking, and meeting aerobic exercise (AE) guidelines (≥500 MET-minutes per week). Results: During an average follow-up of 5 years, 1517 (20%) developed excess body fat and 552 (14%) developed abdominal obesity. Individuals meeting the RE guidelines (30%; 2323 of 7685) had a 26% and 25% lower risk of developing excess body fat (HR: 0.74; 95% CI: 0.65 to 0.84) and abdominal obesity (HR: 0.75; 95% CI: 0.61 to 0.92), respectively, after adjusting for potential confounders including AE. The HRs (95% CIs) of incident abdominal obesity were 0.70 (0.48-1.01), 0.62 (0.44-0.87), 0.98 (0.67-1.42), and 0.62 (0.42-0.91), while the HRs (95% CIs) of incident excess body fat were 0.84 (0.69-1.03), 0.71 (0.59-0.86), 0.75 (0.59-0.96), and 0.56 (0.43-0.72), in weekly RE time of 1-59, 60-119, 120-179, and ≥180 minutes/week, respectively, compared with no RE. In the combined analysis of RE and AE, HRs (95% CIs) of incident excess body fat and abdominal obesity were 0.71 (0.53-0.95) and 0.62 (0.37-1.04) in meeting RE guidelines only, 0.86 (0.77-0.97) and 0.80 (0.66-0.97) in meeting AE guidelines only, and 0.65 (0.56-0.75) and 0.62 (0.49-0.79) in meeting both RE and AE guidelines, respectively, compared with meeting none of the guidelines. Conclusions: We found that RE, independent of and combined with AE, is associated with a reduced risk of developing excess body fat and abdominal obesity.

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Pregnancy, pregnancy loss and the risk of diabetes in Chinese women: findings from the China Kadoorie Biobank

European Journal of Epidemiology ◽

10.1007/s10654-019-00582-7 ◽

2019 ◽

Vol 35 (3) ◽

pp. 295-303

Author(s):

Sanne A. E. Peters ◽

◽

Ling Yang ◽

Yu Guo ◽

Yiping Chen ◽

...

Keyword(s):

Pregnancy Loss ◽

Cox Regression ◽

Chinese Women ◽

Later Life ◽

Induced Abortion ◽

Hazard Ratios ◽

Increased Risk ◽

History Of ◽

Incident Cases

AbstractPregnancy and pregnancy loss may be associated with increased risk of diabetes in later life. However, the evidence is inconsistent and sparse, especially among East Asians where reproductive patterns differ importantly from those in the West. We examined the associations of pregnancy and pregnancy loss (miscarriage, induced abortion, and still birth) with the risk of incident diabetes in later life among Chinese women. In 2004–2008, the nationwide China Kadoorie Biobank recruited 302 669 women aged 30–79 years from 10 (5 urban, 5 rural) diverse localities. During 9.2 years of follow-up, 7780 incident cases of diabetes were recorded among 273,383 women without prior diabetes and cardiovascular disease at baseline. Cox regression yielded multiple-adjusted hazard ratios (HRs) for the risk of diabetes associated with pregnancy and pregnancy loss. Overall, 99% of women had been pregnant, of whom 10%, 53%, and 6% reported having a history of miscarriage, induced abortion, and stillbirth, respectively. Among ever pregnant women, each additional pregnancy was associated with an adjusted HR of 1.04 (95% CI 1.03; 1.06) for diabetes. Compared with those without pregnancy loss, women with a history of pregnancy loss had an adjusted HR of 1.07 (1.02; 1.13) and the HRs increased with increasing number of pregnancy losses, irrespective of the number of livebirths; the adjusted HR was 1.03 (1.00; 1.05) for each additional pregnancy loss. The strength of the relationships differed marginally by type of pregnancy loss. Among Chinese women, a higher number of pregnancies and pregnancy losses were associated with a greater risk of diabetes.

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Weight changes during chemotherapy for breast cancer

Sao Paulo Medical Journal ◽

10.1590/s1516-31802002000400005 ◽

2002 ◽

Vol 120 (4) ◽

pp. 113-117 ◽

Cited By ~ 25

Author(s):

Luciano José Megale Costa ◽

Paulo César Spotti Varella ◽

Auro del Giglio

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Body Weight ◽

Weight Gain ◽

Weight Change ◽

Prognostic Significance ◽

Disease Free Survival ◽

Weight Changes ◽

Free Survival ◽

Disease Free

CONTEXT: Patients receiving adjuvant chemotherapy for breast cancer have a tendency to gain weight. This tendency has determining factors not completely defined and an unknown prognostic impact. OBJECTIVE: To evaluate weight change during chemotherapy for breast cancer in a defined population and to identify its predisposing factors and possible prognostic significance. DESIGN: Observational, retrospective cohort study. SETTING: Private clinical oncology service. PARTICIPANTS: 106 consecutive patients with breast cancer treated between June 1994 and April 2000, who received neoadjuvant (n = 8), adjuvant (n = 74) or palliative (n = 24) chemotherapy. INTERVETION: Review of medical records and gathering of clinical information, including patients’ body weights before treatment and at follow-up reviews. MAIN MEASUREMENTS: Body weight change, expressed as percentage of body weight per month in treatment; role of clinical data in weight change; and influence of weight change in overall survival and disease-free survival. RESULTS: There was a mean increase of 0.50 ± 1.42% (p = 0.21) of body weight per month of treatment. We noted a negative correlation between metastatic disease and weight gain (r = -0.447, p < 0.0001). In the adjuvant and neoadjuvant therapy groups there was a mean weight gain of 0.91 ± 1.19 % (p < 0.00001) per month, whereas in the metastatic (palliative) group, we observed a mean loss of 0.52 ± 1.21% (p = 0.11) of body weight per month during the treatment. We did not observe any statistically significant correlation between weight changes and disease-free survival or overall survival. CONCLUSIONS: Women with breast cancer undergoing adjuvant or neoadjuvant chemotherapy gain weight, whereas metastatic cancer patients will probably lose weight during palliative chemotherapy. Further studies are needed in order to evaluate the prognostic significance of weight changes during chemotherapy.

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Metformin Use Is Associated with a Lower Risk of Inflammatory Bowel Disease in Patients with Type 2 Diabetes Mellitus

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa136 ◽

2020 ◽

Cited By ~ 1

Author(s):

Chin-Hsiao Tseng

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Inflammatory Bowel Disease ◽

Type 2 Diabetes Mellitus ◽

Bowel Disease ◽

Cox Regression ◽

Reference Group ◽

Hazard Ratios ◽

Inflammatory Bowel

Abstract Aim Our aim was to compare the risk of developing inflammatory bowel disease [IBD] between ever users and never users of metformin. Methods Patients with newly diagnosed type 2 diabetes mellitus from 1999 to 2005 were enrolled from Taiwan’s National Health Insurance. A total of 340 211 ever users and 24 478 never users who were free from IBD on January 1, 2006 were followed up until December 31, 2011. Hazard ratios were estimated by Cox regression incorporating the inverse probability of treatment weighting using a propensity score. Results New-onset IBD was diagnosed in 6466 ever users and 750 never users. The respective incidence rates were 412.0 and 741.3 per 100 000 person-years and the hazard ratio for ever vs never users was 0.55 [95% confidence interval: 0.51–0.60]. A dose–response pattern was observed while comparing the tertiles of cumulative duration of metformin therapy to never users. The respective hazard ratios for the first [<26.0 months], second [26.0–58.3 months] and third [>58.3 months] tertiles were 1.00 [0.93–1.09], 0.57 [0.52–0.62] and 0.24 [0.22–0.26]. While patients treated with oral antidiabetic drugs [OADs] without metformin were treated as a reference group, the hazard ratios for patients treated with OADs with metformin, with insulin without metformin [with/without other OADs] and with insulin and metformin [with/without other OADs] were 0.52 [0.42–0.66], 0.95 [0.76–1.20] and 0.50 [0.40–0.62], respectively. Conclusion A reduced risk of IBD is consistently observed in patients with type 2 diabetes mellitus who have been treated with metformin.

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Pre-eclampsia and risk of later kidney disease: nationwide cohort study

BMJ ◽

10.1136/bmj.l1516 ◽

2019 ◽

pp. l1516 ◽

Cited By ~ 22

Author(s):

Jonas H Kristensen ◽

Saima Basit ◽

Jan Wohlfahrt ◽

Mette Brimnes Damholt ◽

Heather A Boyd

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Outcome Measure ◽

Cox Regression ◽

Hazard Ratio ◽

Hazard Ratios ◽

Gestational Age At Delivery ◽

History Of

ABSTRACTObjectiveTo investigate associations between pre-eclampsia and later risk of kidney disease.DesignNationwide register based cohort study.SettingDenmark.PopulationAll women with at least one pregnancy lasting at least 20 weeks between 1978 and 2015.Main outcome measureHazard ratios comparing rates of kidney disease between women with and without a history of pre-eclampsia, stratified by gestational age at delivery and estimated using Cox regression.ResultsThe cohort consisted of 1 072 330 women followed for 19 994 470 person years (average 18.6 years/woman). Compared with women with no previous pre-eclampsia, those with a history of pre-eclampsia were more likely to develop chronic renal conditions: hazard ratio 3.93 (95% confidence interval 2.90 to 5.33, for early preterm pre-eclampsia (delivery <34 weeks); 2.81 (2.13 to 3.71) for late preterm pre-eclampsia (delivery 34-36 weeks); 2.27 (2.02 to 2.55) for term pre-eclampsia (delivery ≥37 weeks). In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest.Conclusions Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.

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Weight change over two years in people prescribed olanzapine, quetiapine and risperidone in UK primary care: Cohort study in THIN, a UK primary care database

Journal of Psychopharmacology ◽

10.1177/0269881118780011 ◽

2018 ◽

Vol 32 (10) ◽

pp. 1098-1103 ◽

Cited By ~ 3

Author(s):

David PJ Osborn ◽

Irene Petersen ◽

Nick Beckley ◽

Kate Walters ◽

Irwin Nazareth ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Weight Gain ◽

Confidence Interval ◽

Weight Change ◽

Antipsychotic Treatment ◽

Weight Changes ◽

Baseline Weight ◽

Care Database

Background: Follow-up studies of weight gain related to antipsychotic treatment beyond a year are limited in number. We compared weight change in the three most commonly prescribed antipsychotics in a representative UK General Practice database. Method: We conducted a cohort study in United Kingdom primary care records of people newly prescribed olanzapine, quetiapine or risperidone. The primary outcome was weight in each six month period for two years after treatment initiation. Weight changes were compared using linear regression, adjusted for age, baseline weight and diagnosis. Results: N = 6338 people received olanzapine, 12,984 quetiapine and 6556 risperidone. Baseline weight was lowest for men treated with olanzapine (80.8 kg versus 83.5 kg quetiapine, 82.0 kg risperidone) and women treated with olanzapine (67.7 kg versus 71.5 kg quetiapine 68.4 kg risperidone. Weight gain occurred during treatment with all three drugs. Compared with risperidone mean weight gain was higher with olanzapine (adjusted co-efficient +1.24 kg (95% confidence interval: 0.69–1.79 kg per six months) for men and +0.77 kg (95% confidence interval: 0.29–1.24 kg) for women). Weight gain with quetiapine was lower in unadjusted models compared with risperidone, but this difference was not significant after adjustment. Conclusion: Olanzapine is more commonly prescribed to people with lower weight. However, after accounting for baseline weight, age, sex and diagnosis, olanzapine is still associated with greater weight gain over two years than risperidone or quetiapine. Baseline weight does not ameliorate the risks of weight gain associated with antipsychotic medication. Weight gain should be assertively discussed and managed for people prescribed antipsychotics, especially olanzapine.

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Mortality in Patients with Diabetic Foot Ulcers: Causes, Risk Factors, and Their Association with Evolution and Severity of Ulcer

Journal of Clinical Medicine ◽

10.3390/jcm9093009 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3009

Author(s):

José Antonio Rubio ◽

Sara Jiménez ◽

José Luis Lázaro-Martínez

Keyword(s):

Diabetic Foot ◽

Cox Regression ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Hazard Ratios ◽

History Of

Background: This study reviews the mortality of patients with diabetic foot ulcers (DFU) from the first consultation with a Multidisciplinary Diabetic Foot Team (MDFT) and analyzes the main cause of death, as well as the relevant clinical factors associated with survival. Methods: Data of 338 consecutive patients referred to the MDFT center for a new DFU during the 2008–2014 period were analyzed. Follow-up: until death or until 30 April 2020, for up to 12.2 years. Results: Clinical characteristics: median age was 71 years, 92.9% had type 2 diabetes, and about 50% had micro-macrovascular complications. Ulcer characteristics: Wagner grade 1–2 (82.3%), ischemic (49.2%), and infected ulcers (56.2%). During follow-up, 201 patients died (59.5%), 110 (54.7%) due to cardiovascular disease. Kaplan—Meier curves estimated a reduction in survival of 60% with a 95% confidence interval (95% CI), (54.7–65.3) at 5 years. Cox regression analysis adjusted to a multivariate model showed the following associations with mortality, with hazard ratios (HRs) (95% CI): age, 1.07 (1.05–1.08); HbA1c value < 7% (53 mmol/mol), 1.43 (1.02–2.0); active smoking, 1.59 (1.02–2.47); ischemic heart or cerebrovascular disease, 1.55 (1.15–2.11); chronic kidney disease, 1.86 (1.37–2.53); and ulcer severity (SINBAD system) 1.12 (1.02–1.26). Conclusion: Patients with a history of DFU have high mortality. Two less known predictors of mortality were identified: HbA1c value < 7% (53 mmol/mol) and ulcer severity.

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