Effects of fasting blood glucose levels and blood pressure and treatment of diabetes and hypertension on the incidence of cardiovascular disease: a study of 740 patients with incident Type 2 diabetes with up to 30 years' follow-up

• Published in: Diabetic medicine 2014-09, Vol.31 (9), p.1055-1063
• Main Authors: Jansson, S. P. O., Svärdsudd, K., Andersson, D. K. G.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antihypertensive Agents - therapeutic use; Biological and medical sciences; Blood Glucose - metabolism; Blood Pressure; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fasting; Feeding. Feeding behavior; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Humans; Hypertension - drug therapy; Hypertension - physiopathology; Hypoglycemic Agents - therapeutic use; Incidence; Male; Medical sciences; Metformin - therapeutic use; Middle Aged; Myocardial Infarction - epidemiology; Myocardial Infarction - physiopathology; Odds Ratio; Primary Health Care; Risk Factors; Sex Factors; Stroke - epidemiology; Stroke - physiopathology; Sulfonylurea Compounds - therapeutic use; Sweden - epidemiology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology
• ISSN: 0742-3071; 1464-5491; 1464-5491
• DOI: 10.1111/dme.12514

Aims To analyse the effects of hyperglycaemia and hypertension and treatment of diabetes and hypertension on cardiovascular disease incidence in patients with Type 2 diabetes with up to 30 years of follow‐up. Methods A total of 740 patients with incident Type 2 diabetes were registered at the Laxå Primary Health Care Centre, Sweden between 1972 and 2001. Annual data on mean fasting blood glucose, systolic, diastolic and mean arterial blood pressure, and type of diabetes and hypertension treatment were obtained from patient records, and information on cardiovascular disease, myocardial infarction and stroke events was obtained from national registers. Results During the follow‐up period, cumulative cardiovascular disease incidence increased significantly with male sex (hazard ratio 1.48, 95% CI 1.21–1.82), number of previous cardiovascular disease events (hazard ratio 1.13, 95% CI 1.08–1.18), age, per year (HR 1.05, 95% CI 1.04–1.07), mean fasting blood glucose, per mmol/l (hazard ratio 1.05, 95% CI 1.00–1.10) BMI (hazard ratio 1.04, 95% CI 1.01–1.06), mean arterial blood pressure, per mmHg (hazard ratio 1.02, 95% CI 1.01–1.03), and decreased significantly with metformin treatment (hazard ratio 0.58, 95% CI 0.38–0.90) and sulfonylurea (hazard ratio 0.73, 95% CI 0.55–0.97). Cumulative myocardial infarction incidence increased significantly with male sex, number of previous myocardial infarction events, mean fasting blood glucose level, BMI, age and mean arterial blood pressure, and decreased with metformin treatment. Cumulative stroke incidence increased with number of previous stroke events, age and mean arterial blood pressure. Conclusions The cumulative incidence of cardiovascular disease and myocardial infarction increased with number of previous events and presence of hyperglycaemia and hypertension and decreased with pharmacological treatment of diabetes. A higher number of previous stroke events increased the cumulative incidence of stroke but no protective effect of pharmacological treatment was observed.