Differential prognostic burden of cardiovascular disease and lower-limb amputation on the risk of all-cause death in people with long-standing type 1 diabetes

Cardiovascular Diabetology

André Scheen¹  Elise Gand²  Alice Larroumet³  Vincent Rigalleau³  Kamel Mohammedi³  Marion Camoin³  Michel Marre⁴  Gilberto Velho⁴  Samy Hadjadj⁵  Olivier Bourron⁶  Charlyne Carpentier⁷  Severine Dubois⁷  Ronan Roussel⁸  Louis Potier⁸  Yawa Abouleka⁸  Lyse Bordier⁹  Pierre-Jean Saulnier^1,10 

[1] CHU Liège, Liège Université;Centre d’Investigation Clinique, CHU de Poitiers;Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque;INEM, INSERM, Université de Paris;Institut du Thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes;Service de Diabétologie et Métabolisme, APHP, Groupe Hospitalier La Pitié-Salpêtrière, Sorbonne Université;Service d’Endocrinologie Diabétologie Nutrition, CHU d’Angers;Service d’Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris;Service d’Endocrinologie, Hôpital Bégin;UFR de Médecine et Pharmacie, Université de Poitiers;

关键词: Lower-limb amputation;    Cardiovascular disease;    Mortality;    Myocardial infarction;    Stroke;    Type 1 diabetes mellitus;   

DOI  :  10.1186/s12933-022-01487-8

来源: DOAJ

【 摘 要 】

Abstract Background Cardiovascular disease (CVD) and nontraumatic lower-limb amputation (LLA) each results in reduced life expectancy in patients with type 1 diabetes, but the differential burden between these conditions is unknown. We compared the effects of CVD and LLA on the risk of mortality in people with type 1 diabetes. Methods We used pooled data from the SURGENE, GENEDIAB, and GENESIS prospective cohorts. Data were divided into: 1/absence of CVD (myocardial infarction and/or stroke) nor LLA, 2/history of CVD alone without LLA, 3/LLA alone without CVD or 4/both conditions at baseline. Participants with baseline history of peripheral artery disease were excluded from groups 1 and 2. The study endpoint was any death occurring during follow-up, regardless of the causes. Results Among 1169 participants (male 55%, age 40 ± 13 years, diabetes duration 23 ± 11 years), CVD, LLA or both were present at baseline in 49 (4.2%), 62 (5.3%) and 20 (1.7%) subjects, respectively. All-cause death occurred in 304 (26%) participants during 17-year follow-up, corresponding to 18,426 person-years and an incidence rate of 16 (95%CI, 15–18) per 1000 person-years. The risk of death increased in individuals with baseline history of CVD (adjusted HR 2.00 [95% CI 1.34–3.01], p = 0.0008) or LLA (2.26 [1.56–3.28], p < 0.0001), versus no condition, with an additive effect in people with both conditions (5.32 [3.14–9.00], p < 0.0001). No incremental risk of death was observed in people with CVD versus LLA (0.87 [0.54–1.41]). Compared with no condition, CVD and LLA were similarly associated with reduced life expectancy during follow-up: 2.79 (95% CI 1.26–4.32) and 3.38 (1.87–4.88) years, respectively. Combined conditions expose to 7.04 (4.76–9.31) less years of life expectancy (all p < 0.0001). Conclusions CVD and LLA conferred a similar burden regarding mortality in type 1 diabetes population. Our findings encourage a careful consideration of people with type 1 diabetes and LLA as usually recommended for those with CVD, in terms of management of risk factors, treatments and prevention.

【 授权许可】

Unknown