Effects of fasting blood glucose, diabetes treatment, blood pressure and anti-hypertension treatment on cardiovascular disease incidence: a 30-year follow-up study of 740 incident patients with Type 2 diabetes

• Published in: Diabetic medicine 2013-03, Vol.30 (3), p.349-357
• Main Authors: JANSSON, S. P. O, ANDERSSON, D. K. G, SVÄRDSUDD, K
• Format: Article
• Language: English
• Subjects: Administration; Administration, Oral; Aged; Antihypertensive Agents; Antihypertensive Agents - therapeutic use; Biological and medical sciences; Blood Glucose; Blood Glucose - metabolism; Blood Pressure; Blood Pressure - physiology; Diabetes; Diabetes Mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies; Diabetic Angiopathies - complications; Diabetic Angiopathies - drug therapy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fasting; Fasting - blood; Feeding. Feeding behavior; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Humans; Hyperglycemia; Hyperglycemia - complications; Hypertension; Hypertension - complications; Hypertension - drug therapy; Hypoglycemic Agents; Hypoglycemic Agents - administration & dosage; Internal Medicine; Invärtesmedicin; Male; Medical sciences; Middle Aged; Myocardial Infarction; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Oral; Stroke; Stroke - complications; Stroke - drug therapy; Type 2; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology
• ISSN: 0742-3071; 1464-5491; 1464-5491
• DOI: 10.1111/dme.12106

To analyse the effects of hyperglycaemia and blood pressure, diabetes and anti-hypertension treatment on total and various types of cardiovascular disease incidence in patients with Type 2 diabetes followed for 30 years. A total of 740 incident patients with Type 2 diabetes were registered at the Laxå Primary Health Care Centre, Sweden between 1972 and 2001. Information on systolic, diastolic, and mean arterial blood pressure, mean fasting blood glucose, type of diabetes and anti-hypertension treatment was obtained from the patient records, and information on cardiovascular disease, myocardial infarction and stroke events from National Registers. During the follow-up period the cumulative incidence of cardiovascular disease increased significantly with male sex (HR 1.52, 95% CI 1.25-1.85), age (HR 1.05, 95% CI 1.04-1.07), year of diabetes onset (HR 1.03, 95% CI 1.01-1.05), BMI, (HR 1.04, 95% CI 1.02-1.07), mean arterial blood pressure (HR 1.04, 95% CI 1.02-1.05) and number of previous cardiovascular disease events (HR 1.15, 95% CI 1.10-1.21), and decreased significantly with sulfonylurea treatment (HR 0.64, 95% CI 0.49-0.84), insulin (HR 0.57, 95% CI 0.33-0.98) and calcium channel blocker treatment (HR, 0.69, 95% CI 0.48-0.99). Cumulative incidence of myocardial infarction increased significantly with male sex, age, BMI, mean arterial blood pressure, number of previous myocardial infarction events and diuretic treatment, and decreased with metformin treatment. Cumulative incidence of stroke increased with age, year of diabetes onset, mean arterial blood pressure, and previous number of stroke events. Cumulative cardiovascular disease, myocardial infarction and incidence of stroke increased with number of previous events and presence of hypertension and decreased with pharmacological anti-diabetic treatment and, to a lesser extent, with anti-hypertension treatment.