Statin use reduces cardiovascular events and all-cause mortality amongst Chinese patients with type 2 diabetes mellitus: a 5-year cohort study

Objective To estimate long-term hazards of all-cause mortality following a diagnosis of type 2 diabetes mellitus (T2DM) using electronic primary care data. Methodology Retrospective matched cohort study using electronic health records from THIN primary care database. The study included individuals born between 1930 and 1960, diagnosed with T2DM between 2000 and 2016 and aged 50-74 years and excluded those with pre-existing stroke, cancer, cognitive impairment, lower limb amputation or chronic kidney disease (CKD) stages 3 to 5. T2DM individuals were matched at diagnosis to at most 3 controls by age, gender and general practice (GP) and followed up to 1 January 2017. Time-varying hazards of all-cause mortality were then estimated using Gompertz-double-Cox model with frailty on GP, adjusting for medical history, socio-demographic and lifestyle factors. Results A total of 221 182 (57.6% Males, 30.8% T2DM) individuals were selected for the study of whom 29 618 (13.4%) died during follow-up. The adjusted mortality hazard of type 2 diabetes mellitus (T2DM) was estimated to be 1.21[1.12-1.3] and 1.52[1.44-1.6] among individuals diagnosed at 50-59 years and 60-74 years, respectively, compared to controls. Deprivation, obesity, smoking and comorbidities affected survival of cases and controls equally. Compared to the 1930-39 birth cohort, all-cause mortality hazards were reduced in the 1940-49 cohort, but increased at older ages in the 1950-60 birth cohort for both cases and controls. Conclusion T2DM is associated with raised all-cause mortality hazards which increase with age of diagnosis. These hazards associated with age at diagnosis are constant across all birth cohorts demonstrating a lack of progress over time in reducing the relative risks of all-cause mortality associated with T2DM. A further study that includes people born after 1960 is needed to fully understand the emerging higher mortality hazards among the younger birth cohorts.

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Atherogenic index of plasma is associated with major adverse cardiovascular events in patients with type 2 diabetes mellitus

10.21203/rs.3.rs-829355/v1 ◽

2021 ◽

Author(s):

Liyao Fu ◽

Ying Zhou ◽

Jiaxing Sun ◽

Zhaowei Zhu ◽

Zhenhua Xing ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cardiovascular Events ◽

Atherogenic Index ◽

Confounding Factors ◽

Atherogenic Index Of Plasma ◽

All Cause Mortality ◽

Study Population

Abstract Background Previous studies have reported the prognostic value of the atherogenic index of plasma (AIP) in the course of atherosclerosis and other cardiovascular diseases (CVDs). However, the utility of the AIP for prediction is unknown among patients with type 2 diabetes mellitus (T2DM). Methods This was a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study which randomized 10,251 patients with long-lasting T2DM. ROC curve analysis was used to determine an optimal threshold for AIP and the study population was divided into high and low AIP groups. Univariate and multivariate Cox proportional hazards regression analyses were used to find the association between AIP and primary (MACEs) and second outcomes (all-cause mortality). Stratified analyses were performed to control the confounding factors. Results AIP was an independent risk factor for the prognosis of T2DM (HR = 1.309; 95% CI, 1.084–1.581; P = 0.005). The threshold for AIP was determined to be 0.34 among the study population. After adjustments for confounding factors, multivariate analysis showed that AIP was associated with the risk of MACEs (Model 1: HR = 1.333, 95%CI: 1.205–1.474, P༜0.001; Model 2: HR = 1.171, 95%CI: 1.030–1.333, P = 0.016; Model 3: HR = 1.194, 95%CI: 1.049–1.360, P = 0.007) and all-cause mortality (Model 1: HR = 1.184, 95%CI: 1.077–1.303, P༜0.001), especially cardiovascular deaths (Model 1: HR = 1.422, 95%CI: 1.201–1.683, P༜0.001; Model 3: HR = 1.264, 95%CI: 1.015–1.573, P = 0.036) and nonfatal myocardial infarction (Model 1: HR = 1.447, 95%CI: 1.255–1.669, P༜0.001; Model 2: HR = 1.252, 95%CI: 1.045–1.499, P = 0.015; Model 3: HR = 1.284, 95%CI: 1.071–1.539, P = 0.007). Subgroup stratified analyses showed that AIP might interact with gender, a classical risk factor of cardiovascular events. Conclusions Our study showed that AIP might be a strong biomarker that could be used to predict the risk of cardiovascular events in patients with T2DM.

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