High Risk of Cardiovascular Disease in Patients With Type 1 Diabetes in the U.K.

A cohort study using the General Practice Research Database

  1. Sabita S. Soedamah-Muthu, PHD12,
  2. John H. Fuller, MD1,
  3. Henrietta E. Mulnier, MSC3,
  4. Veena S. Raleigh, PHD34,
  5. Ross A. Lawrenson, MD3 and
  6. Helen M. Colhoun, MD15
  1. 1Department of Epidemiology and Public Health, Royal Free and University College London Medical School, London, U.K.
  2. 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
  3. 3Postgraduate Medical School, University of Surrey, Guildford, Surrey, U.K.
  4. 4Healthcare Commission, Finsbury Tower, London, U.K.
  5. 5Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
  1. Address correspondence and reprint requests to S.S. Soedamah-Muthu, University Medical Centre Utrecht, Julius Center for Health Sciences and Primary Care, Huispostnr str.6.131, P.O. Box 85500, 3508 GA. Utrecht. E-mail: s.s.soedamah-muthu{at}umcutrecht.nl

Abstract

OBJECTIVE—To estimate the absolute and relative risk of cardiovascular disease (CVD) in patients with type 1 diabetes in the U.K.

RESEARCH DESIGN AND METHODS—Subjects with type 1 diabetes (n = 7,479) and five age- and sex-matched subjects without diabetes (n = 38,116) and free of CVD at baseline were selected from the General Practice Research Database (GPRD), a large primary care database representative of the U.K. population. Incident major CVD events, comprising myocardial infarction, acute coronary heart disease death, coronary revascularizations, or stroke, were captured for the period 1992–1999.

RESULTS—The hazard ratio (HR) for major CVD was 3.6 (95% CI 2.9–4.5) in type 1 diabetic men compared with those without diabetes and 7.7 (5.5–10.7) in women. Increased HRs were found for acute coronary events (3.0 and 7.6 in type 1 diabetic men and women, respectively, versus nondiabetic subjects), coronary revascularizations (5.0 in men, 16.8 in women), and for stroke (3.7 in men, 4.8 in women). Type 1 diabetic men aged 45–55 years had an absolute CVD risk similar to that of men in the general population 10–15 years older, with an even greater difference in women.

CONCLUSIONS—Despite advances in care, these data show that absolute and relative risks of CVD remain extremely high in patients with type 1 diabetes. Women with type 1 diabetes continue to experience greater relative risks of CVD than men compared with those without diabetes.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted December 24, 2005.
    • Received August 1, 2005.
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