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Objectives:  To compare the risk associated with systolic blood pressure that meets current recommendations (that is, below 140 mm Hg) with the risk associated with lower levels in patients who have type 2 diabetes and no previous cardiovascular disease., Design:  Population based cohort study with nationwide clinical registries, 2006-12. The mean follow-up was 5.0 years., Setting:  861 Swedish primary care units and hospital outpatient clinics., Participants:  187 106 patients registered in the Swedish national diabetes register who had had type 2 diabetes for at least a year, age 75 or younger, and with no previous cardiovascular or other major disease., Main Outcome Measures:  Clinical events were obtained from the hospital discharge and death registers with respect to acute myocardial infarction, stroke, a composite of acute myocardial infarction and stroke (cardiovascular disease), coronary heart disease, heart failure, and total mortality. Hazard ratios were estimated for different levels of baseline systolic blood pressure with clinical characteristics and drug prescription data as covariates., Results:  The group with the lowest systolic blood pressure (110-119 mm Hg) had a significantly lower risk of non-fatal acute myocardial infarction (adjusted hazard ratio 0.76, 95% confidence interval 0.64 to 0.91; P=0.003), total acute myocardial infarction (0.85, 0.72 to 0.99; P=0.04), non-fatal cardiovascular disease (0.82, 0.72 to 0.93; P=0.002), total cardiovascular disease (0.88, 0.79 to 0.99; P=0.04), and non-fatal coronary heart disease (0.88, 0.78 to 0.99; P=0.03) compared with the reference group (130-139 mm Hg). There was no indication of a J shaped relation between systolic blood pressure and the endpoints, with the exception of heart failure and total mortality., Conclusions:  Lower systolic blood pressure than currently recommended is associated with significantly lower risk of cardiovascular events in patients with type 2 diabetes. The association between low blood pressure and increased mortality could be due to concomitant disease rather than antihypertensive treatment., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Aims/hypothesis: We assessed the relationship between BP and risk of cardiovascular events (CVEs) and all-cause mortality in patients with type 2 diabetes and renal impairment (estimated GFR < 60 ml min(-1) 1.73 m(-2)) treated in clinical practice., Methods: A total of 33,356 patients (aged 75 ± 9 years, diabetes duration of 10 ± 8 years) with at least one serum creatinine and BP value available in the Swedish National Diabetes Register between 2005 and 2007 were followed up until 2011 or death. The relationships between mean BPs, CVEs and all-cause mortality were examined using time-dependent Cox models to estimate HRs, adjusting for cardiovascular risk factors and ongoing medications., Results: During the follow-up period (mean 5.3 years), 11,317 CVEs and 10,738 deaths occurred. The lowest risks of CVEs and all-cause mortality were observed with a systolic BP (SBP) of 135-139 and a diastolic BP (DBP) of 72-74 mmHg, and the highest risks were observed for those with SBP intervals 80-120 (CVE HR 2.3 [95% CI 2.0, 2.6] and all-cause mortality HR 2.4, [95% CI 2.1, 2.7]) and 160-230 mmHg (CVE HR 3.0 [95% CI 2.6, 3.3] and all-cause mortality HR 2.0 [95% CI 1.8-2.3]) and DBP intervals 40-63 mmHg (CVE HR 2.0 [95% CI 1.8, 2.2], all-cause mortality HR 2.0 [95% CI 1.8, 2.2]) and 83-125 mmHg (CVE HR 2.3 [95% CI 2.0, 2.5], all-cause mortality HR 2.3 [95% CI 2.0, 2.6])., Conclusions/interpretation: In this nationwide cohort of patients with type 2 diabetes and renal impairment, the risk of CVEs and all-cause mortality increased significantly with both high and low BPs, while an SBP of 135-139 mmHg and DBP of 72-74 mmHg were associated with the lowest risks of CVEs and death.

Background: People with type 1 diabetes often live for many years with different combinations of diabetes-related complications. We aimed to quantify how complication duration and total complication burden affect mortality, using data from national registers.Methods: This study included 33 396 individuals with type 1 diabetes, registered in the Swedish National Diabetes Register at any time between 2001 and 2012. Each individual was followed and classified according to their time-updated diabetes-related complication status. The main outcomes were all-cause mortality, cardiovascular (CV) mortality and non-CV mortality. Poisson models were used to estimate the rate of these outcomes as a function of the time-updated complication duration.Results: Overall, 1748 of the 33 396 individuals died during 198 872 person-years of follow-up. Overall, the time-updated all-cause mortality rate ratio (MRR) was 2.25 [95% confidence interval (CI): 1.99-2.54] for patients with diabetic kidney disease, 0.98 (0.82-1.18) for patients with retinopathy and 4.00 (3.56-4.50) for patients with cardiovascular disease relative to individuals without complications. The excess rate was highest in the first period after a diagnosis of CVD, with an 8-fold higher mortality rate, and stabilized after some 5 years. After diagnosis of diabetic kidney disease, we observed an increase in all-cause mortality with an MRR of around 2 compared with individuals without diabetic kidney disease, which stabilized after few years.Conclusions: In this cohort we show that duration of diabetes-related complications is an important determinant of mortality in type 1 diabetes, for example the MRR associated with CVD is highest in the first period after diagnosis of CVD. A stronger focus on time-updated information and thorough consideration of complication duration may improve risk stratification in routine clinical practice. [ABSTRACT FROM AUTHOR]

Aims: To compare stroke incidence in people with type 2 diabetes (T2D) with that in a matched control group, and to investigate whether glucose exposure in people with T2D can predict a first‐time stroke event and mortality. Material and methods: In a nationwide observational cohort study, individuals with T2D were linked in the Swedish National Diabetes Register and matched with five individual population‐based control subjects. We calculated crude incidence rates and 95% confidence intervals (CIs), and used Cox regression and multivariable hazard ratios (HRs), to estimate the risk of stroke and mortality in relation to glycated haemoglobin (HbA1c) levels. Results: A total of 406 271 people with T2D (age 64.1 ± 12.4 years, 45.7% women) and 2086 440 control subjects (age 64.0 ± 12.4 years, 45.7% women) were included. During a median follow‐up of 7.3 years, 26 380 people with T2D (6.5%) versus 92 375 control subjects (4.4%) were diagnosed with a stroke. The incidence rate was 10.12 events per 1000 person‐years versus 7.26 events per 1000 person‐years (HR 1.54, 95% CI 1.52‐1.56). In the T2D group after multivariable adjustments, the HRs for stroke stratified by HbA1c level were: 54‐64 mmol/mol: 1.27 (95% CI 1.22‐1.32); 65‐75 mmol/mol: 1.68 (95% CI 1.60‐1.76); 76‐86 mmol/mol: 1.89 (95% CI, 1.75‐2.05); and > 87 mmol/mol: 2.14 (95% CI 1.90‐2.42), respectively, compared with the reference category of HbA1c ≤53 mmol/mol. There was a stepwise increased risk of death after stroke, for every 10‐mmol/mol categorical increment of HbA1c (HR 1.71; 95% CI 1.47‐2.00) for the highest HbA1c category. Conclusions: An increased risk of stroke and death was associated with poor glycaemic control in people with T2D. [ABSTRACT FROM AUTHOR]

Epidemiological data indicate decreased risk for development and growth of abdominal aortic aneurysm (AAA) among patients with diabetes mellitus (DM). On the other hand, DM adds to increased cardiovascular (CV) morbidity and mortality. In a nationwide observational cohort study of patients registered in the Swedish Vascular Register and the Swedish National Diabetes Register, we evaluated potential effects of DM on total mortality, CV morbidity, and the need for reintervention after elective endovascular aneurysm repair (EVAR) for AAA. We compared 748 patients with and 2630 without DM with propensity score-adjusted analysis, during a median 4.22 years of follow-up for patients with DM, and 4.05 years for those without. In adjusted analysis, diabetic patients showed higher rates of acute myocardial infarction (AMI) during follow-up (relative risk (RR) 1.44, 95% CI 1.06–1.95; p = 0.02), but lower need for reintervention (RR 0.12, CI 0.02–0.91; p = 0.04). There were no differences in total (RR 0.88, CI 0.74–1.05; p = 0.15) or CV (RR 1.58, CI 0.87–2.86; p = 0.13) mortality, or stroke (RR 0.95, CI 0.68–1.32; p = 0.75) during follow-up. In conclusion, patients with DM had higher rates of AMI and lower need for reintervention after elective EVAR than those without DM, whereas neither total nor CV mortality differed between groups. The putative protective effects of DM towards further AAA enlargement and late sac rupture may help explain the lower need for reintervention and absence of excess mortality. [ABSTRACT FROM AUTHOR]

Objective: Low weight has been associated with increased mortality risks in type 1 diabetes. We aimed to investigate the importance of weight and weight gain/loss in the Swedish population diagnosed with type 1 diabetes.Research Design and Methods: Patients with type 1 diabetes (n = 26,125; mean age 33.3 years; 45% women) registered in the Swedish National Diabetes Registry from 1998 to 2012 were followed from the first day of study entry. Cox regression was used to calculate risk of death from cardiovascular disease (CVD), major CVD events, hospitalizations for heart failure (HF), and total deaths.Results: Population mean BMI in patients with type 1 diabetes increased from 24.7 to 25.7 kg/m2 from 1998 to 2012. Over a median follow-up of 10.9 years, there were 1,031 deaths (33.2% from CVD), 1,460 major CVD events, and 580 hospitalizations for HF. After exclusion of smokers, patients with poor metabolic control, and patients with a short follow-up time, there was no increased risk for mortality in those with BMI <25 kg/m2, while BMI >25 kg/m2 was associated with a minor increase in risk of mortality, major CVD, and HF. In women, associations with BMI were largely absent. Weight gain implied an increased risk of mortality and HF, while weight loss was not associated with higher risk.Conclusions: Risk of major CVD, HF, CVD death, and mortality increased with increasing BMI, with associations more apparent in men than in women. After exclusion of factors associated with reverse causality, there was no evidence of an obesity paradox. [ABSTRACT FROM AUTHOR]

Objective: Type 2 diabetes is strongly associated with obesity, but the mortality risk related to elevated body weight in people with type 2 diabetes compared with people without diabetes has not been established.Research Design and Methods: We prospectively assessed short- and long-term mortality in people with type 2 diabetes with a recorded diabetes duration ≤5 years identified from the Swedish National Diabetes Register (NDR) between 1998 and 2012 and five age- and sex-matched control subjects per study participant from the general population.Results: Over a median follow-up of 5.5 years, there were 17,546 deaths among 149,345 patients with type 2 diabetes (mean age 59.6 years [40% women]) and 68,429 deaths among 743,907 matched control subjects. Short-term all-cause mortality risk (≤5 years) displayed a U-shaped relationship with BMI, with hazard ratios (HRs) ranging from 0.81 (95% CI 0.75-0.88) among patients with diabetes and BMI 30 to <35 kg/m2 to 1.37 (95% CI 1.11-1.71) with BMI ≥40 kg/m2 compared with control subjects after multiple adjustments. Long-term, all weight categories showed increased mortality, with a nadir at BMI 25 to <30 kg/m2 and a stepwise increase up to HR 2.00 (95% CI 1.58-2.54) among patients with BMI ≥40 kg/m2, that was more pronounced in patients <65 years old.Conclusions: Our findings suggest that the apparent paradoxical findings in other studies in this area may have been affected by reverse causality. Long-term, overweight (BMI 25 to <30 kg/m2) patients with type 2 diabetes had low excess mortality risk compared with control subjects, whereas risk in those with BMI ≥40 kg/m2 was substantially increased. [ABSTRACT FROM AUTHOR]

Objective: Our hypothesis was that patients with diabetes mellitus obtain an additional risk of death if they develop Addison's disease (AD). Design and methods: Nationwide, matched, observational cohort study cross-referencing the Swedish National Diabetes Register with Inpatient, Cancer and Cause of Death Registers in patients with diabetes (type 1 and 2) and AD and matched controls with diabetes. Clinical characteristics at baseline, overall, and cause-specific mortality were assessed. The relative risk of death was assessed using a Cox proportional hazards regression model. Results: Between January 1996 and December 2012, 226 patients with diabetes and AD were identified and matched with 1129 controls with diabetes. Median (interquartile range) follow-up was 5.9 (2.7-8.6) years. When patients with diabetes were diagnosed with AD, they had an increased frequency of diabetes complications, but both medical history of cancer and coronary heart disease did not differ compared with controls. Sixty-four of the 226 patients with diabetes and AD (28%) died, while 112 of the 1129 controls (10%) died. The estimated relative risk increase (hazard ratio) in overall mortality in the diabetes and AD group was 3.89 (95% confidence interval 2.84-5.32) compared with controls with diabetes. The most common cause of death was cardiovascular in both groups, but patients with diabetes and AD showed an increased death rate from diabetes complications, infectious diseases and unknown causes. Conclusions: Patients with the rare combination of diabetes and AD showed a markedly increased mortality and died more frequently from infections and unknown causes than patients with diabetes alone. Improved strategy for the management of this combination of metabolic disorders is needed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of lipid-lowering therapy (LLT) in primary prevention on cardiovascular disease (CVD) and death in type 1 diabetes.Research Design and Methods: We used the Swedish National Diabetes Register (NDR) to perform a propensity score-based study. Propensity scores for treatment with LLT were calculated from 32 baseline clinical and socioeconomic variables. The propensity score was used to estimate the effect of LLT in the overall cohort (by stratification). We estimated risk of acute myocardial infarction, stroke, coronary heart disease, and cardiovascular and all-cause mortality in individuals with and without LLT using Cox regression. A total of 24,230 individuals included in 2006-2008 NDR with type 1 diabetes without a history of CVD were followed until 31 December 2012; 18,843 were untreated and 5,387 treated with LLT (97% statins). The mean follow-up was 6.0 years.Results: The propensity score allowed balancing of all 32 covariates, with no differences between treated and untreated after accounting for propensity score. Hazard ratios (HRs) for treated versus untreated were as follows: cardiovascular death 0.60 (95% CI 0.50-0.72), all-cause death 0.56 (0.48-0.64), fatal/nonfatal stroke 0.56 (0.46-0.70), fatal/nonfatal acute myocardial infarction 0.78 (0.66-0.92), fatal/nonfatal coronary heart disease 0.85 (0.74-0.97), and fatal/nonfatal CVD 0.77 (0.69-0.87).Conclusions: This observational study shows that LLT is associated with 22-44% reduction in the risk of CVD and cardiovascular death among individuals with type 1 diabetes without history of CVD and underlines the importance of primary prevention with LLT to reduce cardiovascular risk in type 1 diabetes. [ABSTRACT FROM AUTHOR]

OBJECTIVE Socioeconomic status (SES) is a powerful predictor of cardiovascular disease (CVD) and death. We examined the association in a large cohort of patients with type 1 diabetes. RESEARCH DESIGN AND METHODS Clinical data from the Swedish National Diabetes Register were linked to national registers, whereby information on income, education, marital status, country of birth, comorbidities, and events was obtained. Patients were followed until a first incident event, death, or end of follow-up. The association between socioeconomic variables and the outcomes was modeled using Cox regression, with rigorous covariate adjustment. RESULTS We included 24,947 patients. Mean (SD) age and follow-up was 39.1 (13.9) and 6.0 (1.0) years. Death and fatal/nonfatal CVD occurred in 926 and 1378 individuals. Compared with being single, being married was associated with 50% lower risk of death, cardiovascular (CV) death, and diabetes-related death. Individuals in the two lowest quintiles had twice as great a risk of fatal/nonfatal CVD, coronary heart disease, and stroke and roughly three times as great a risk of death, diabetes-related death, and CV death as individuals in the highest income quintile. Compared with having ≤9 years of education, individuals with a college/university degree had 33% lower risk of fatal/nonfatal stroke. Immigrants had 19%, 33%, and 45% lower risk of fatal/nonfatal CVD, all-cause death, and diabetes-related death, respectively, compared with Swedes. Men had 44%, 63%, and 29% greater risk of all-cause death, CV death, and diabetes-related death. CONCLUSIONS Low SES increases the risk of CVD and death by a factor of 2-3 in type 1 diabetes. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The aim of this study was to investigate the influence of diabetes on treatment and outcome in acute myocardial infarction (AMI), during two time periods, in two countries, and to assess whether this influence has changed over the past decades. Methods: Patients, aged 30 to 74, with a diagnosis of AMI in two urban areas–Göteborg, Sweden and Minneapolis-St. Paul, Minnesota, USA–hospitalized during 1990–1991 and 1995–1996 were included. The primary endpoint was 7-year all-cause mortality. Results: The study included 3824 patients, 734 (19%) had diabetes. Age-adjusted in-hospital mortality of diabetic patients was nearly twofold higher compared with non-diabetic patients (9.8% vs. 5.0%, p <0.05). Between 1990–1991 and 1995–1996 in-hospital mortality declined for both diabetic (11.9% vs. 7.6%, p =0.07) and non-diabetic (6.3% vs. 3.6%, p =0.002) patients. A history of diabetes was associated with nearly twofold higher long-term mortality rate (48.5% vs. 26%, p <0.05). Seven-year mortality was reduced between 1990–1991 and 1995–1996 in both diabetic (51.6% vs. 45.2%, p =0.13) and non-diabetic patients (29.3% vs. 22.1%, p <0.0001) (The results did not reach statistical significance for diabetic patients, due to smaller sample size.) During their hospital stay, diabetic patients received significantly less aspirin, beta-blockers and thrombolysis. After adjustment, a history of diabetes remained significantly associated with 7-year mortality following AMI, doubling the hazard of death (hazard ratio (HR)=2.11; 95% confidence interval (CI): 1.80–2.46). Conclusion: A history of diabetes is associated with nearly twofold higher long-term mortality rate and is independently associated with 7-year mortality following AMI. Short- and long-term mortality decreased from 1990 to 1995 in both non-diabetic and diabetic patients. Underutilization of evidence-based treatments contributes to the remaining increased mortality in diabetic patients with acute coronary disease. [Copyright &y& Elsevier]

Epidemiologic data indicate decreased risk for development, growth, and rupture of abdominal aortic aneurysm (AAA) among patients with type 2 diabetes mellitus (DM). We therefore evaluated mortality and cardiovascular morbidity after acute repair of AAA in diabetic and nondiabetic patients. In this nationwide observational cohort study of patients registered in the Swedish Vascular Registry and the Swedish National Diabetes Register, we compared mortality and morbidity after acute open (n = 1357 [61%]) or endovascular (n = 860 [39%]) repair of ruptured (n = 1469 [66%]) or otherwise symptomatic (n = 748 [34%]) AAAs in 363 patients with and 1854 patients without DM with propensity score-adjusted analysis. Follow-up was 3.91 years for patients with DM and 3.18 years for those without. In propensity-adjusted analysis, diabetic patients showed lower total mortality (relative risk [RR], 0.75; 95% confidence interval [CI], 0.59-0.95; P =.016) and cardiovascular mortality (RR, 0.17; 95% CI, 0.06-0.50; P =.01) than those without DM, whereas there were no differences in rates of major adverse cardiovascular events (RR, 1.10; 95% CI, 0.87-1.42; P =.42), acute myocardial infarction (RR, 1.36; 95% CI, 0.70-2.63; P =.37), or stroke (RR, 1.31; 95% CI, 0.84-2.03; P =.23). Patients with type 2 DM had lower rates of both total and cardiovascular mortality after acute AAA repair than those without DM, whereas rates of cardiovascular events, acute myocardial infarction, and stroke did not differ between groups. This might be explained by putative protective effects of DM on the aortic wall. [ABSTRACT FROM AUTHOR]

A response by Marcus Lind and colleagues to a letter to the editor about their article "Glycemic Control and Excess Mortality in Type 1 Diabetes" in the November 20, 2014 issue is presented.

Aims: To examine if personnel resources and organisational features in Swedish primary health-care centres (PHCCs) are associated to all-cause mortality (ACM) in people with type 2 diabetes mellitus (T2DM).Methods: A total of 187,570 people with T2DM registered in the Swedish National Diabetes Register (NDR) during 2013 were included in this nationwide cohort study. Individual NDR data were linked to data from a questionnaire addressing personnel resources and organisational features for 787 (68%) PHCCs as well as to individual data on socio-economic status and comorbidities. Furthermore, data on ACM were obtained and followed up until 30 January 2018. Hierarchical Cox regression analyses were applied.Results: After a median follow-up of 4.2 years, 27,136 (14.5%) participants had died. An association was found between number of whole-time-equivalent (WTE) general practitioner's (GP's) devoted to diabetes care/500 people with T2DM and lower risk of early death (hazard ratio 0.919 [95% confidence interval 0.895-0.945] per additional WTE GP; p = 0.002). No other personnel resources or organisational features were significantly associated with ACM.Conclusions: This nationwide register-based cohort study suggests that the number of WTE GPs devoted to diabetes care have an impact on the risk of early death in people with T2DM. [ABSTRACT FROM AUTHOR]

Background: The strength of association and optimal levels for risk factors related to excess risk of death and cardiovascular outcomes in type 1 diabetes mellitus have been sparsely studied.Methods: In a national observational cohort study from the Swedish National Diabetes Register from 1998 to 2014, we assessed relative prognostic importance of 17 risk factors for death and cardiovascular outcomes in individuals with type 1 diabetes mellitus. We used Cox regression and machine learning analyses. In addition, we examined optimal cut point levels for glycohemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol. Patients with type 1 diabetes mellitus were followed up until death or study end on December 31, 2013. The primary outcomes were death resulting from all causes, fatal/nonfatal acute myocardial infarction, fatal/nonfatal stroke, and hospitalization for heart failure.Results: Of 32 611 patients with type 1 diabetes mellitus, 1809 (5.5%) died during follow-up over 10.4 years. The strongest predictors for death and cardiovascular outcomes were glycohemoglobin, albuminuria, duration of diabetes mellitus, systolic blood pressure, and low-density lipoprotein cholesterol. Glycohemoglobin displayed ≈2% higher risk for each 1-mmol/mol increase (equating to ≈22% per 1% glycohemoglobin difference), whereas low-density lipoprotein cholesterol was associated with 35% to 50% greater risk for each 1-mmol/L increase. Microalbuminuria or macroalbuminuria was associated with 2 to 4 times greater risk for cardiovascular complications and death. Glycohemoglobin <53 mmol/mol (7.0%), systolic blood pressure <140 mm Hg, and low-density lipoprotein cholesterol <2.5 mmol/L were associated with significantly lower risk for outcomes observed.Conclusions: Glycohemoglobin, albuminuria, duration of diabetes mellitus, systolic blood pressure, and low-density lipoprotein cholesterol appear to be the most important predictors for mortality and cardiovascular outcomes in patients with type 1 diabetes mellitus. Lower levels for glycohemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol than contemporary guideline target levels appear to be associated with significantly lower risk for outcomes. [ABSTRACT FROM AUTHOR]

Background: Long-term trends in excess risk of death and cardiovascular outcomes have not been extensively studied in persons with type 1 diabetes or type 2 diabetes.Methods: We included patients registered in the Swedish National Diabetes Register from 1998 through 2012 and followed them through 2014. Trends in deaths and cardiovascular events were estimated with Cox regression and standardized incidence rates. For each patient, controls who were matched for age, sex, and county were randomly selected from the general population.Results: Among patients with type 1 diabetes, absolute changes during the study period in the incidence rates of sentinel outcomes per 10,000 person-years were as follows: death from any cause, -31.4 (95% confidence interval [CI], -56.1 to -6.7); death from cardiovascular disease, -26.0 (95% CI, -42.6 to -9.4); death from coronary heart disease, -21.7 (95% CI, -37.1 to -6.4); and hospitalization for cardiovascular disease, -45.7 (95% CI, -71.4 to -20.1). Absolute changes per 10,000 person-years among patients with type 2 diabetes were as follows: death from any cause, -69.6 (95% CI, -95.9 to -43.2); death from cardiovascular disease, -110.0 (95% CI, -128.9 to -91.1); death from coronary heart disease, -91.9 (95% CI, -108.9 to -75.0); and hospitalization for cardiovascular disease, -203.6 (95% CI, -230.9 to -176.3). Patients with type 1 diabetes had roughly 40% greater reduction in cardiovascular outcomes than controls, and patients with type 2 diabetes had roughly 20% greater reduction than controls. Reductions in fatal outcomes were similar in patients with type 1 diabetes and controls, whereas patients with type 2 diabetes had smaller reductions in fatal outcomes than controls.Conclusions: In Sweden from 1998 through 2014, mortality and the incidence of cardiovascular outcomes declined substantially among persons with diabetes, although fatal outcomes declined less among those with type 2 diabetes than among controls. (Funded by the Swedish Association of Local Authorities and Regions and others.). [ABSTRACT FROM AUTHOR]

The article presents a research study on glycated hemoglobin A1c levels in type 1 diabetes mellitus (T1DM) and outcomes after myocardial infarction (MI). The study comprised all T1DM patients who had an MI between 1995 to 2013 in Sweden, identified using the National Patient Register. It is concluded that higher HbA1c levels were associated with a greater risk of recurrent MI, death, and heart failure.

Aim: We assessed the association between risk factors and cardiovascular disease (CVD) in an observational study of type 2 diabetes patients from the Swedish National Diabetes Register.Methods: A derivation sample of 24,288 patients, aged 30-74 years, 15.3% with previous CVD, baseline 2002, 2488 CVD events when followed for 5 years until 2007. A separate validation data set of 4906 patients, baseline 2003, 522 CVD events when followed for 4 years.Results: Adjusted hazard ratios at Cox regression for fatal/nonfatal CVD were: onset-age 1.59, diabetes duration 1.55, total-cholesterol-to-HDL-cholesterol ratio 1.20, HbA1c 1.12, systolic BP 1.09, BMI 1.07 (1 SD increase in natural log continuous variables); males 1.41, smoker 1.35, microalbuminuria 1.27, macroalbuminuria 1.53, atrial fibrillation 1.50, previous CVD 1.98 (all p<0.001 except BMI p=0.0018). All 12 variables were used to elaborate an equation for 5-year CVD risk in the derivation dataset: mean 5-year risk 11.9±8.4%. Calibration in the validation dataset was adequate: ratio predicted 4-year risk/observed rate 0.97. Discrimination was sufficient: C statistic 0.72, sensitivity 51% and specificity 78% for top quartile.Conclusion: This CVD risk model from a large observational study of patients in routine care showed adequate calibration and discrimination, and can be useful for clinical practice. [ABSTRACT FROM AUTHOR]