scholarly journals Considerably decreased risk of cardiovascular disease with combined reductions in HbA1c, blood pressure and blood lipids in type 2 diabetes: Report from the Swedish National Diabetes Register

2016 ◽  
Vol 13 (4) ◽  
pp. 268-277 ◽  
Author(s):  
Katarina Eeg-Olofsson ◽  
Björn Zethelius ◽  
Soffia Gudbjörnsdottir ◽  
Björn Eliasson ◽  
Ann-Marie Svensson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Systolic Blood Pressure ◽  
Reference Group ◽  
Baseline Hba1c ◽  
Diabetes Register

Objectives: Assess the effect of risk factors changes on risk for cardiovascular disease and mortality in patients with type 2 diabetes selected from the Swedish National Diabetes Register. Methods: Observational study of 13,477 females and males aged 30–75 years, with baseline HbA1c 41–67 mmol/mol, systolic blood pressure 122–154 mmHg and ratio non-HDL:HDL 1.7–4.1, followed for mean 6.5 years until 2012. Four groups were created: a reference group ( n = 6757) with increasing final versus baseline HbA1c, systolic blood pressure and non-HDL:HDL cholesterol during the study period, and three groups with decreasing HbA1c ( n = 1925), HbA1c and systolic blood pressure ( n = 2050) or HbA1c and systolic blood pressure and non-HDL:HDL ( n = 2745). Results: Relative risk reduction for fatal/nonfatal cardiovascular disease was 35% with decrease in HbA1c only (mean 6 to final 49 mmol/mol), 56% with decrease in HbA1c and systolic blood pressure (mean 12 to final 128 mmHg) and 75% with combined decreases in HbA1c, systolic blood pressure and non-HDL:HDL (mean 0.8 to final 2.1), all p < 0.001 adjusting for clinical characteristics, other risk factors, treatments and previous cardiovascular disease. Similar risk reductions were found for fatal/nonfatal coronary heart disease, fatal cardiovascular disease, all-cause mortality and also in a subgroup of 3038 patients with albuminuria. Conclusion: Considerable risk reductions for cardiovascular disease and mortality were seen with combined long-term risk factor improvement.

scholarly journals Exploring potential mediators of the cardiovascular benefit of dulaglutide in type 2 diabetes patients in REWIND

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Manige Konig ◽  
Matthew C. Riddle ◽  
Helen M. Colhoun ◽  
Kelley R. Branch ◽  
Charles M. Atisso ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Systolic Blood Pressure ◽  
Repeated Measures ◽  
Cox Regression ◽  
Cox Model ◽  
Hazard Ratio ◽  
Major Adverse Cardiovascular Events

Abstract Background The REWIND trial demonstrated cardiovascular (CV) benefits to patients with type 2 diabetes and multiple CV risk factors or established CV disease. This exploratory analysis evaluated the degree to which the effect of dulaglutide on CV risk factors could statistically account for its effects on major adverse cardiovascular events (MACE) in the REWIND trial. Methods Potential mediators of established CV risk factors that were significantly reduced by dulaglutide were assessed in a post hoc analysis using repeated measures mixed models and included glycated hemoglobin (HbA1c), body weight, waist-to-hip ratio, systolic blood pressure, low-density lipoprotein (LDL), and urine albumin/creatinine ratio (UACR). These factors, for which the change in level during follow-up was significantly associated with incident MACE, were identified using Cox regression modeling. Each identified variable was then included as a covariate in the Cox model assessing the effect of dulaglutide on MACE to estimate the degree to which the hazard ratio of dulaglutide vs placebo was attenuated. The combined effect of the variables associated with attenuation was assessed by including all variables in an additional Cox model. Results Although all evaluated variables were significantly improved by treatment, only changes in HbA1c and UACR were associated with MACE and a reduction in the effect of dulaglutide on this outcome was observed. The observed hazard ratio for MACE for dulaglutide vs placebo reduced by 36.1% by the updated mean HbA1c, and by 28.5% by the updated mean UACR. A similar pattern was observed for change from baseline in HbA1c and UACR and a reduction of 16.7% and 25.4%, respectively in the hazard ratio for MACE with dulaglutide vs placebo was observed. When HbA1c and UACR were both included, the observed hazard ratio reduced by 65.4% for the updated mean and 41.7% for the change from baseline with no HbA1c-UACR interaction (P interaction = 0.75 and 0.15, respectively). Conclusions Treatment-induced improvement in HbA1c and UACR, but not changes in weight, systolic blood pressure, or LDL cholesterol, appear to partly mediate the beneficial effects of dulaglutide on MACE outcomes. These observations suggest that the proven effects of dulaglutide on cardiovascular disease benefit are partially related to changes in glycemic control and albuminuria, with residual unexplained benefit. Clinicaltrials.gov; Trial registration number: NCT01394952. URL: https://clinicaltrials.gov/ct2/show/NCT01394952

Systolic blood pressure and risk of cardiovascular diseases in type 2 diabetes: an observational study from the Swedish national diabetes register

2010 ◽  
Vol 28 (10) ◽  
pp. 2026-2035 ◽  
Author(s):  
Jan Cederholm ◽  
Soffia Gudbjörnsdottir ◽  
Björn Eliasson ◽  
Björn Zethelius ◽  
Katarina Eeg-Olofsson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Diseases ◽  
Observational Study ◽  
Systolic Blood Pressure ◽  
Diabetes Register

scholarly journals Risk Factors of Diabetic Nephropathy Development in Type 2 Diabetic Patients: A Cross-sectional Retrospective Study

2021 ◽  
Author(s):  
Santisith Khiewkhern ◽  
Witaya Yoosook ◽  
Wisit Thongkum ◽  
Chitkamon Srichompoo ◽  
Sawan Thitisutti
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Systolic Blood Pressure ◽  
Survival Time ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Cross Sectional ◽  
Factors Associated

Introduction: Diabetic Nephropathy (DN) is one of the most serious long-term complications of patients with type 2 diabetes and the leading cause of end-stage kidney failure. Early detection and risk reduction measures can prevent DN. However, data showing the survival time and factors associated with DN development among Thai patients with type 2 diabetes is currently not available. Aim: This study aims to explore the survival time and examine the risk factors associated with the development of DN among Thai patients with type 2 diabetes. Materials and Methods: This cross-sectional retrospective study was conducted during 1st January, 2002 to 3rd December, 2017 to performed and to explore the survival time and examine the risk factors associated with the development of DN among 1,540 patients with type 2 diabetes who received treatment at the Diabetes Mellitus (DM) clinic in Mahachanachai Hospital, Yasothon Province, Thailand. Data was collected from the Hospital Experience (HOSxP) program and medical records from 2002 to 2017. Kaplan-Meier and Cox’s regressions were used for data analysis. Results: From those 15 years, out of 1,540 cases 306 eligible patients with type 2 DM were selected for survival analysis. The results showed that 274 patients met the criteria for DN (89.50%) and 32 patients (10.50%) did not meet the criteria for DN. The median of DN survival time was five years. Multivariate Cox’s regression analysis confirmed that systolic blood pressure had a statistically significant association with the development of DN among hospitalised type 2 diabetic patients. Conclusion: Duration of Diabetes and Systolic blood pressure are associated with the development of DN. The application of future prevention and control measures are highly recommended to control systolic blood pressure for DN protection.

scholarly journals Decreased systolic blood pressure is associated with increased risk of all-cause mortality in patients with type 2 diabetes and renal impairment: A nationwide longitudinal observational study of 27,732 patients based on the Swedish National Diabetes Register

2017 ◽  
Vol 14 (3) ◽  
pp. 226-235 ◽  
Author(s):  
Maria K Svensson ◽  
Henri Afghahi ◽  
Stefan Franzen ◽  
Staffan Björk ◽  
Soffia Gudbjörnsdottir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Renal Impairment ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Hazard Ratio ◽  
All Cause Mortality ◽  
Diabetes Register

Background: Previous studies have shown a U-shaped relationship between systolic blood pressure and risk of all-cause of mortality in patients with type 2 diabetes and renal impairment. Aims: To evaluate the associations between time-updated systolic blood pressure and time-updated change in systolic blood pressure during the follow-up period and risk of all-cause mortality in patients with type 2 diabetes and renal impairment. Patients and methods: A total of 27,732 patients with type 2 diabetes and renal impairment in the Swedish National Diabetes Register were followed for 4.7 years. Time-dependent Cox models were used to estimate risk of all-cause mortality. Time-updated mean systolic blood pressure is the average of the baseline and the reported post-baseline systolic blood pressures. Results: A time-updated systolic blood pressure < 130 mmHg was associated with a higher risk of all-cause mortality in patients both with and without a history of chronic heart failure (hazard ratio: 1.25, 95% confidence interval: 1.13–1.40 and hazard ratio: 1.26, 1.17–1.36, respectively). A time-updated decrease in systolic blood pressure > 10 mmHg between the last two observations was associated with higher risk of all-cause mortality (−10 to −25 mmHg; hazard ratio: 1.24, 95% confidence interval: 1.17–1.32). Conclusion: Both low systolic blood pressure and a decrease in systolic blood pressure during the follow-up are associated with a higher risk of all-cause mortality in patients with type 2 diabetes and renal impairment.

scholarly journals Impact of Isolated High Home Systolic Blood Pressure and Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus: A 5-Year Prospective Cohort Study

2021 ◽  
Vol 10 (9) ◽  
pp. 1929
Author(s):  
Nobuko Kitagawa ◽  
Noriyuki Kitagawa ◽  
Emi Ushigome ◽  
Hidetaka Ushigome ◽  
Isao Yokota ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cohort Study ◽  
Diabetic Nephropathy ◽  
Systolic Blood Pressure ◽  
Odds Ratio

Background: A previous 2-year cohort study has shown that isolated high home systolic blood pressure (IH-HSBP) may increase the risk of diabetic nephropathy, using normal HBP as a reference. However, this association has not been previously assessed in the medium to long term. Methods: This prospective 5-year cohort study of 424 patients, with normal or mildly increased albuminuria, investigated the effect of IH-HSBP on the risk of diabetic nephropathy in patients with type 2 diabetes mellitus. Diabetic nephropathy was defined as an advancement from normal or mildly increased albuminuira to moderate or severely increased albuminuria. Results: Among 424 patients, 75 developed diabetic nephropathy during the study period. The adjusted odds ratio for developing diabetic nephropathy given IH-HSBP was 2.39 (95% confidence interval, 1.15–4.96, p = 0.02). The odds ratio for developing nephropathy in patients with IH-HSBP younger than 65 years was higher than that in patients with IH-HSBP older than 65 years. Conclusion: IH-HSBP was associated with an increased risk of diabetic nephropathy among type 2 diabetes mellitus patients with normal or mildly increased albuminuria in the medium to long term. The results support and strengthen previous reports. These findings suggest that IH-HSBP might be a useful marker in disease prognostication.

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