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Association between refill adherence to lipid-lowering medications and the risk of cardiovascular disease and mortality in Swedish patients with type 2 diabetes mellitus: a nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature298616
Source
BMJ Open. 2018 03 30; 8(3):e020309
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
03-30-2018
Author
Sofia Axia Karlsson
Christel Hero
Ann-Marie Svensson
Stefan Franzén
Mervete Miftaraj
Soffia Gudbjörnsdottir
Katarina Eeg-Olofsson
Björn Eliasson
Karolina Andersson Sundell
Author Affiliation
Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Source
BMJ Open. 2018 03 30; 8(3):e020309
Date
03-30-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cardiovascular Diseases - drug therapy - prevention & control
Cohort Studies
Diabetes Mellitus, Type 2 - complications
Female
Humans
Hypolipidemic Agents - administration & dosage
Lipids
Male
Medication Adherence
Middle Aged
Sweden
Young Adult
Abstract
To analyse the association between refill adherence to lipid-lowering medications, and the risk of cardiovascular disease (CVD) and mortality in patients with type 2 diabetes mellitus.
Cohort study.
National population-based cohort of Swedish patients with type 2 diabetes mellitus.
86?568 patients aged =18 years, registered with type 2 diabetes mellitus in the Swedish National Diabetes Register, who filled at least one prescription for lipid-lowering medication use during 2007-2010, 87% for primary prevention.
Refill adherence of implementation was assessed using the medication possession ratio (MPR), representing the proportion of days with medications on hand during an 18-month exposure period. MPR was categorised by five levels (=20%, 21%-40%, 41%-60%, 61%-80% and >80%). Patients without medications on hand for =180 days were defined as non-persistent. Risk of CVD (myocardial infarction, ischaemic heart disease, stroke and unstable angina) and mortality by level of MPR and persistence was analysed after the exposure period using Cox proportional hazards regression and Kaplan-Meier, adjusted for demographics, socioeconomic status, concurrent medications and clinical characteristics.
The hazard ratios for CVD ranged 1.33-2.36 in primary prevention patients and 1.19-1.58 in secondary prevention patients, for those with MPR =80% (p
PubMed ID
29602853 View in PubMed
Less detail

Association Between Use of Lipid-Lowering Therapy and Cardiovascular Diseases and Death in Individuals With Type 1 Diabetes.

https://arctichealth.org/en/permalink/ahliterature286766
Source
Diabetes Care. 2016 Jun;39(6):996-1003
Publication Type
Article
Date
Jun-2016
Author
Christel Hero
Araz Rawshani
Ann-Marie Svensson
Stefan Franzén
Björn Eliasson
Katarina Eeg-Olofsson
Soffia Gudbjörnsdottir
Source
Diabetes Care. 2016 Jun;39(6):996-1003
Date
Jun-2016
Language
English
Publication Type
Article
Keywords
Adult
Cardiovascular Diseases - epidemiology - mortality
Case-Control Studies
Cause of Death
Coronary Disease - epidemiology - mortality
Diabetes Mellitus, Type 1 - epidemiology
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hyperlipidemias - drug therapy - epidemiology
Male
Middle Aged
Myocardial Infarction - epidemiology - mortality
Propensity Score
Proportional Hazards Models
Registries
Risk factors
Stroke - epidemiology - mortality
Sweden - epidemiology
Young Adult
Abstract
To evaluate the effect of lipid-lowering therapy (LLT) in primary prevention on cardiovascular disease (CVD) and death in type 1 diabetes.
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.
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).
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.
PubMed ID
27208327 View in PubMed
Less detail

Blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease: national population based cohort study.

https://arctichealth.org/en/permalink/ahliterature281358
Source
BMJ. 2016 Aug 04;354:i4070
Publication Type
Article
Date
Aug-04-2016
Author
Samuel Adamsson Eryd
Soffia Gudbjörnsdottir
Karin Manhem
Annika Rosengren
Ann-Marie Svensson
Mervete Miftaraj
Stefan Franzén
Staffan Björck
Source
BMJ. 2016 Aug 04;354:i4070
Date
Aug-04-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Blood pressure
Cardiovascular Diseases - epidemiology
Coronary Disease - epidemiology
Diabetes Mellitus, Type 2 - epidemiology
Female
Heart Failure - epidemiology
Humans
Male
Middle Aged
Mortality
Myocardial Infarction - epidemiology
Practice Guidelines as Topic
Registries
Risk assessment
Stroke - epidemiology
Sweden - epidemiology
Systole
Abstract
 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.
 Population based cohort study with nationwide clinical registries, 2006-12. The mean follow-up was 5.0 years.
 861 Swedish primary care units and hospital outpatient clinics.
 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.
 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.
 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.
 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.
Notes
Cites: Clin Chem. 1972 Jun;18(6):499-5024337382
Cites: J Am Coll Cardiol. 2012 Jan 3;59(1):74-8322192672
Cites: J Hypertens. 2012 Oct;30(10):2020-3022871895
Cites: N Engl J Med. 2010 Apr 29;362(17):1575-8520228401
Cites: BMC Public Health. 2011 Jun 09;11:45021658213
Cites: Ann Intern Med. 1999 Mar 16;130(6):461-7010075613
Cites: Lancet. 2016 Jan 30;387(10017):435-4326559744
Cites: Diabetes Care. 2003 Apr;26(4):1270-612663609
Cites: Int J Epidemiol. 2000 Jun;29(3):495-50210869322
Cites: Clin Diabetes. 2016 Jan;34(1):3-2126807004
Cites: N Engl J Med. 2015 Nov 26;373(22):2175-826551394
Cites: N Engl J Med. 2015 Oct 29;373(18):1720-3226510021
Cites: Circulation. 2011 Jun 21;123(24):2799-810, 9 p following 81021632497
Cites: JAMA. 2015 Feb 10;313(6):603-1525668264
Cites: Pharmacoepidemiol Drug Saf. 2007 Jul;16(7):726-3516897791
Cites: Lancet. 2002 Dec 14;360(9349):1903-1312493255
Cites: BMJ. 2016 Feb 24;352:i71726920333
Cites: J Hypertens. 2013 Jul;31(7):1281-35723817082
Cites: JAMA. 2014 Feb 5;311(5):507-2024352797
Cites: N Engl J Med. 2015 Nov 26;373(22):2103-1626551272
Cites: JAMA. 2010 Jul 7;304(1):61-820606150
Cites: Lancet. 2016 Mar 5;387(10022):957-6726724178
PubMed ID
27492939 View in PubMed
Less detail

Can rheumatoid arthritis (RA) registries provide contextual safety data for modern RA clinical trials? The case for mortality and cardiovascular disease.

https://arctichealth.org/en/permalink/ahliterature282349
Source
Ann Rheum Dis. 2016 Oct;75(10):1797-805
Publication Type
Article
Date
Oct-2016
Author
Kaleb Michaud
Niklas Berglind
Stefan Franzén
Thomas Frisell
Christopher Garwood
Jeffrey D Greenberg
Meilien Ho
Marie Holmqvist
Laura Horne
Eisuke Inoue
Fredrik Nyberg
Dimitrios A Pappas
George Reed
Deborah Symmons
Eiichi Tanaka
Trung N Tran
Suzanne M M Verstappen
Eveline Wesby-van Swaay
Hisashi Yamanaka
Johan Askling
Source
Ann Rheum Dis. 2016 Oct;75(10):1797-805
Date
Oct-2016
Language
English
Publication Type
Article
Keywords
Aged
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - complications - drug therapy
Bias (epidemiology)
Cardiovascular Diseases - etiology - mortality
Europe - epidemiology
Female
Humans
India - epidemiology
Japan - epidemiology
Latin America - epidemiology
Male
Middle Aged
Myocardial Infarction - epidemiology - etiology
North America - epidemiology
Randomized Controlled Trials as Topic - statistics & numerical data
Registries - statistics & numerical data
Sweden - epidemiology
Treatment Outcome
Abstract
We implemented a novel method for providing contextual adverse event rates for a randomised controlled trial (RCT) programme through coordinated analyses of five RA registries, focusing here on cardiovascular disease (CVD) and mortality.
Each participating registry (Consortium of Rheumatology Researchers of North America (CORRONA) (USA), Swedish Rheumatology Quality of Care Register (SRR) (Sweden), Norfolk Arthritis Register (NOAR) (UK), CORRONA International (East Europe, Latin America, India) and Institute of Rheumatology, Rheumatoid Arthritis (IORRA) (Japan)) defined a main cohort from January 2000 onwards. To address comparability and potential bias, we harmonised event definitions and defined several subcohorts for sensitivity analyses based on disease activity, treatment, calendar time, duration of follow-up and RCT exclusions. Rates were standardised for age, sex and, in one sensitivity analysis, also HAQ.
The combined registry cohorts included 57 251 patients with RA (234 089 person-years)-24.5% men, mean (SD) baseline age 58.2 (13.8) and RA duration 8.2 (11.7) years. Standardised registry mortality rates (per 100 person-years) varied from 0.42 (CORRONA) to 0.80 (NOAR), with 0.60 for RCT patients. Myocardial infarction and major adverse cardiovascular events (MACE) rates ranged from 0.09 and 0.31 (IORRA) to 0.39 and 0.77 (SRR), with RCT rates intermediate (0.18 and 0.42), respectively. Additional subcohort analyses showed small and mostly consistent changes across registries, retaining reasonable consistency in rates across the Western registries. Additional standardisation for HAQ returned higher mortality and MACE registry rates.
This coordinated approach to contextualising RA RCT safety data demonstrated reasonable differences and consistency in rates for mortality and CVD across registries, and comparable RCT rates, and may serve as a model method to supplement clinical trial analyses for drug development programmes.
PubMed ID
26857699 View in PubMed
Less detail

Cardiovascular disease and mortality in patients with type 2 diabetes after bariatric surgery in Sweden: a nationwide, matched, observational cohort study.

https://arctichealth.org/en/permalink/ahliterature275224
Source
Lancet Diabetes Endocrinol. 2015 Nov;3(11):847-54
Publication Type
Article
Date
Nov-2015
Author
Björn Eliasson
Vasileios Liakopoulos
Stefan Franzén
Ingmar Näslund
Ann-Marie Svensson
Johan Ottosson
Soffia Gudbjörnsdottir
Source
Lancet Diabetes Endocrinol. 2015 Nov;3(11):847-54
Date
Nov-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cardiovascular Diseases - complications - mortality - surgery
Child
Child, Preschool
Cohort Studies
Diabetes Mellitus, Type 2 - complications - surgery
Female
Gastric Bypass
Humans
Infant
Infant, Newborn
Kaplan-Meier Estimate
Male
Middle Aged
Obesity - complications - surgery
Proportional Hazards Models
Risk factors
Sweden
Treatment Outcome
Young Adult
Abstract
In patients with diabetes and obesity specifically, no studies have examined mortality after bariatric surgery. We did a nationwide study in Sweden to examine risks of cardiovascular disease and mortality in patients with obesity and diabetes who had undergone bariatric surgery (Roux-en-Y gastric bypass [RYGB]).
In this nationwide, matched, observational cohort study, we merged data for patients who had undergone RYGB registered in the Scandinavian Obesity Surgery Registry with other national databases, and identified matched controls (on the basis of sex, age, BMI, and calendar time [year]) who had not undergone bariatric surgery from the National Diabetes Registry. We assessed risks of cardiovascular disease and death using a Cox proportional-hazards regression model and other methods to examine the treatment effect while accounting for residual confounding. Primary outcomes were total mortality, cardiovascular death, and fatal or non-fatal myocardial infarction.
Between Jan 1, 2007, and Dec 31, 2014, we obtained data for 6132 patients who had undergone RYGB and 6132 control patients who had not. Median follow-up was 3·5 years (IQR 2·1-4·7). We noted a 58% relative risk reduction (hazard ratio [HR] 0·42, 95% CI 0·30-0·57; p
Notes
Comment In: Lancet Diabetes Endocrinol. 2015 Nov;3(11):828-926429403
PubMed ID
26429401 View in PubMed
Less detail

Cardiovascular safety of glucose-lowering agents as add-on medication to metformin treatment in type 2 diabetes: report from the Swedish National Diabetes Register.

https://arctichealth.org/en/permalink/ahliterature286935
Source
Diabetes Obes Metab. 2016 Oct;18(10):990-8
Publication Type
Article
Date
Oct-2016
Author
Nils Ekström
Ann-Marie Svensson
Mervete Miftaraj
Stefan Franzén
Björn Zethelius
Björn Eliasson
Soffia Gudbjörnsdottir
Source
Diabetes Obes Metab. 2016 Oct;18(10):990-8
Date
Oct-2016
Language
English
Publication Type
Article
Keywords
Aged
Blood Glucose - drug effects
Cardiotoxicity - epidemiology
Cardiovascular Diseases - chemically induced - epidemiology - mortality
Coronary Disease - chemically induced - epidemiology - mortality
Diabetes Mellitus, Type 2 - blood - drug therapy - epidemiology - mortality
Dipeptidyl-Peptidase IV Inhibitors - administration & dosage - adverse effects
Drug Therapy, Combination - adverse effects
Female
Glucagon-Like Peptide 1 - agonists
Heart Failure - chemically induced - epidemiology - mortality
Humans
Hypoglycemic Agents - administration & dosage - adverse effects
Insulin - administration & dosage - adverse effects
Male
Metformin - administration & dosage - adverse effects
Middle Aged
Registries - statistics & numerical data
Sulfonylurea Compounds - administration & dosage - adverse effects
Sweden - epidemiology
Thiazolidinediones - administration & dosage - adverse effects
Treatment Outcome
Abstract
To investigate the relative safety of various glucose-lowering agents as add-on medication to metformin in type 2 diabetes in an observational study linking five national health registers.
Patients with type 2 diabetes who had been on metformin monotherapy and started another agent in addition to metformin were eligible for inclusion. The study period was 2005-2012. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of mortality, cardiovascular disease (CVD), coronary heart disease (CHD), stroke and congestive heart failure (CHF) were estimated using Cox proportional hazards models, weighted for a propensity score.
Of the 20?422 patients included in the study, 43% started on second-line treatment with sulphonylurea (SU), 21% basal insulin, 12% thiazolidinedione (TZD), 11% meglitinide, 10% dipeptidyl peptidase-4 (DPP-4) inhibitor, 1% glucagon-like peptide-1 (GLP-1) receptor agonist and 1% acarbose. At the index date, the mean patient age was ~60?years for all groups except the GLP-1 receptor agonist (56.0?years) and SU (62.9?years) groups. Diabetes duration and glycated haemoglobin levels were similar in all groups. When compared with SU, basal insulin was associated with an 18% higher risk and TZD with a 24% lower risk of mortality [HR 1.18 (95% CI 1.03-1.36) and 0.76 (95% CI 0.62-0.94)], respectively. DPP-4 inhibitor treatment was associated with significantly lower risks of CVD, fatal CVD, CHD, fatal CHD and CHF.
This nationwide observational study showed that second-line treatment with TZD and DPP-4 inhibitor as add-on medication to metformin were associated with significantly lower risks of mortality and cardiovascular events compared with SU, whereas basal insulin was associated with a higher risk of mortality.
PubMed ID
27282621 View in PubMed
Less detail

Decreased systolic blood pressure is associated with increased risk of all-cause mortality in patients with type 2 diabetes and renal impairment: A nationwide longitudinal observational study of 27,732 patients based on the Swedish National Diabetes Register.

https://arctichealth.org/en/permalink/ahliterature287811
Source
Diab Vasc Dis Res. 2017 May;14(3):226-235
Publication Type
Article
Date
May-2017
Author
Maria K Svensson
Henri Afghahi
Stefan Franzen
Staffan Björk
Soffia Gudbjörnsdottir
Ann-Marie Svensson
Björn Eliasson
Source
Diab Vasc Dis Res. 2017 May;14(3):226-235
Date
May-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antihypertensive Agents - therapeutic use
Blood Pressure - drug effects
Cause of Death
Diabetes Mellitus, Type 2 - diagnosis - mortality - physiopathology
Diabetic Nephropathies - diagnosis - mortality - physiopathology
Female
Glomerular Filtration Rate
Heart Failure - mortality - physiopathology
Humans
Hypertension - diagnosis - drug therapy - mortality - physiopathology
Kidney - physiopathology
Longitudinal Studies
Male
Prognosis
Proportional Hazards Models
Registries
Risk assessment
Risk factors
Sweden - epidemiology
Systole
Time Factors
Abstract
Previous studies have shown a U-shaped relationship between systolic blood pressure and risk of all-cause of mortality in patients with type 2 diabetes and renal impairment.
To evaluate the associations between time-updated systolic blood pressure and time-updated change in systolic blood pressure during the follow-up period and risk of all-cause mortality in patients with type 2 diabetes and renal impairment.
A total of 27,732 patients with type 2 diabetes and renal impairment in the Swedish National Diabetes Register were followed for 4.7?years. Time-dependent Cox models were used to estimate risk of all-cause mortality. Time-updated mean systolic blood pressure is the average of the baseline and the reported post-baseline systolic blood pressures.
A time-updated systolic blood pressure??10?mmHg between the last two observations was associated with higher risk of all-cause mortality (-10 to -25?mmHg; hazard ratio: 1.24, 95% confidence interval: 1.17-1.32).
Both low systolic blood pressure and a decrease in systolic blood pressure during the follow-up are associated with a higher risk of all-cause mortality in patients with type 2 diabetes and renal impairment.
PubMed ID
28467201 View in PubMed
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Evaluation of the use of Swedish integrated electronic health records and register health care data as support clinical trials in severe asthma: the PACEHR study.

https://arctichealth.org/en/permalink/ahliterature287527
Source
Respir Res. 2016 Nov 15;17(1):152
Publication Type
Article
Date
Nov-15-2016
Author
Stefan Franzén
Christer Janson
Kjell Larsson
Max Petzold
Urban Olsson
Gunnar Magnusson
Gunilla Telg
Gene Colice
Gunnar Johansson
Mats Sundgren
Source
Respir Res. 2016 Nov 15;17(1):152
Date
Nov-15-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anti-Asthmatic Agents - therapeutic use
Asthma - diagnosis - drug therapy - physiopathology
Data Mining
Electronic Health Records
Feasibility Studies
Female
Health Services Research
Hospitals, University
Humans
Logistic Models
Male
Middle Aged
Primary Health Care
Propensity Score
Randomized Controlled Trials as Topic
Registries
Retrospective Studies
Severity of Illness Index
Sweden
Time Factors
Treatment Outcome
Abstract
In the development of new drugs for severe asthma, it is a challenge from an ethical point of view to randomize severe asthma patients to placebo, and to obtain long-term safety data due to discontinuations. The aim of this study was to evaluate the feasibility of using electronic health record (EHR) data to create a real-world reference population of uncontrolled asthmatic patients to supplement the concurrent control/placebo group in long-term studies of asthma.
EHR data from 36 primary care centres and a University hospital in Sweden were linked to Swedish mandatory health registers (2005-2013), creating a population covering 33 890 asthma patients, including data on co-morbidities, risk factors and laboratory/respiratory measurements. A severe asthma EHR reference cohort was established. We used logistic regression to estimate the propensity score (probability) of each RCT or EHR patient existing in the EHR cohort given their covariates.
We created an EHR-derived reference cohort of 240 patients, matching the placebo group (N?=?151) in an RCT of severe asthma. The exacerbation rate during follow-up in the EHR study population was 1.24 (weighted) compared to 0.9 in the RCT placebo group. Patients in the EHR cohort were of similar age as in the RCT placebo group, 50.6 years versus 50.1 years; had slightly higher body mass index 27.0 kg/m2 versus 27.3 kg/m2; and consisted of 40% versus 34% males.
The results indicate that EHRs provide an opportunity to supplement the control group in RCTs of severe diseases.
Notes
Cites: J Intern Med. 2015 Jan;277(1):94-13625174800
Cites: J Med Ethics. 2014 Apr;40(4):219-2423750027
Cites: J Intern Med. 2013 Dec;274(6):547-6023952476
Cites: Eur Respir J. 2014 Feb;43(2):343-7324337046
Cites: Am J Med Qual. 2006 Jul-Aug;21(4):269-7516849784
Cites: J Hum Hypertens. 2010 Apr;24(4):263-7319890371
Cites: Eur Respir J. 2002 Jan;19(1):61-711843329
Cites: PLoS One. 2011 Feb 17;6(2):e1608221379386
Cites: J R Stat Soc Ser A Stat Soc. 2001 Apr 1;174(2):369-38624926156
Cites: Prim Care Respir J. 2009 Dec;18(4):279-8619455269
Cites: J Clin Epidemiol. 2016 Jan;69:235-4426344809
Cites: Stud Health Technol Inform. 2015;216:153-726262029
Cites: Int J Chron Obstruct Pulmon Dis. 2009;4:203-2319554195
Cites: J Biomed Inform. 2015 Feb;53:162-7325463966
Cites: Lancet Respir Med. 2015 Sep;3(9):692-70126231288
Cites: Thorax. 2016 Mar;71(3):267-7526732738
Cites: Int J Qual Health Care. 2013 Apr;25(2):118-2423360809
Cites: Eur Respir J. 2015 Sep;46(3):622-3926206872
Cites: J Intern Med. 2013 Jun;273(6):584-9423495860
Cites: Eur Respir J. 2001 Sep;18(3):598-61111589359
Cites: Ups J Med Sci. 2012 Mar;117(1):52-622335391
Cites: Contemp Clin Trials. 2016 Jan;46:85-9126600286
Cites: Am J Epidemiol. 2010 Jul 1;172(1):107-1520547574
PubMed ID
27842551 View in PubMed
Less detail

Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study.

https://arctichealth.org/en/permalink/ahliterature295128
Source
Lancet. 2018 08 11; 392(10146):477-486
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
08-11-2018
Author
Araz Rawshani
Naveed Sattar
Stefan Franzén
Aidin Rawshani
Andrew T Hattersley
Ann-Marie Svensson
Björn Eliasson
Soffia Gudbjörnsdottir
Author Affiliation
Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. Electronic address: araz.rawshani@gu.se.
Source
Lancet. 2018 08 11; 392(10146):477-486
Date
08-11-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Age Factors
Age of Onset
Cardiovascular Diseases - epidemiology - etiology
Child
Child, Preschool
Cohort Studies
Diabetes Complications - mortality
Diabetes Mellitus, Type 1 - mortality
Female
Humans
Infant
Infant, Newborn
Male
Proportional Hazards Models
Registries
Sweden - epidemiology
Young Adult
Abstract
People with type 1 diabetes are at elevated risk of mortality and cardiovascular disease, yet current guidelines do not consider age of onset as an important risk stratifier. We aimed to examine how age at diagnosis of type 1 diabetes relates to excess mortality and cardiovascular risk.
We did a nationwide, register-based cohort study of individuals with type 1 diabetes in the Swedish National Diabetes Register and matched controls from the general population. We included patients with at least one registration between Jan 1, 1998, and Dec 31, 2012. Using Cox regression, and with adjustment for diabetes duration, we estimated the excess risk of all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, acute myocardial infarction, stroke, cardiovascular disease (a composite of acute myocardial infarction and stroke), coronary heart disease, heart failure, and atrial fibrillation. Individuals with type 1 diabetes were categorised into five groups, according to age at diagnosis: 0-10 years, 11-15 years, 16-20 years, 21-25 years, and 26-30 years.
27?195 individuals with type 1 diabetes and 135?178 matched controls were selected for this study. 959 individuals with type 1 diabetes and 1501 controls died during follow-up (median follow-up was 10 years). Patients who developed type 1 diabetes at 0-10 years of age had hazard ratios of 4·11 (95% CI 3·24-5·22) for all-cause mortality, 7·38 (3·65-14·94) for cardiovascular mortality, 3·96 (3·06-5·11) for non-cardiovascular mortality, 11·44 (7·95-16·44) for cardiovascular disease, 30·50 (19·98-46·57) for coronary heart disease, 30·95 (17·59-54·45) for acute myocardial infarction, 6·45 (4·04-10·31) for stroke, 12·90 (7·39-22·51) for heart failure, and 1·17 (0·62-2·20) for atrial fibrillation. Corresponding hazard ratios for individuals who developed type 1 diabetes aged 26-30 years were 2·83 (95% CI 2·38-3·37) for all-cause mortality, 3·64 (2·34-5·66) for cardiovascular mortality, 2·78 (2·29-3·38) for non-cardiovascular mortality, 3·85 (3·05-4·87) for cardiovascular disease, 6·08 (4·71-7·84) for coronary heart disease, 5·77 (4·08-8·16) for acute myocardial infarction, 3·22 (2·35-4·42) for stroke, 5·07 (3·55-7·22) for heart failure, and 1·18 (0·79-1·77) for atrial fibrillation; hence the excess risk differed by up to five times across the diagnosis age groups. The highest overall incidence rate, noted for all-cause mortality, was 1·9 (95% CI 1·71-2·11) per 100?000 person-years for people with type 1 diabetes. Development of type 1 diabetes before 10 years of age resulted in a loss of 17·7 life-years (95% CI 14·5-20·4) for women and 14·2 life-years (12·1-18·2) for men.
Age at onset of type 1 diabetes is an important determinant of survival, as well as all cardiovascular outcomes, with highest excess risk in women. Greater focus on cardioprotection might be warranted in people with early-onset type 1 diabetes.
Swedish Heart and Lung Foundation.
Notes
CommentIn: Lancet. 2018 Aug 11;392(10146):453-454 PMID 30129445
PubMed ID
30129464 View in PubMed
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How comparable are rates of malignancies in patients with rheumatoid arthritis across the world? A comparison of cancer rates, and means to optimise their comparability, in five RA registries.

https://arctichealth.org/en/permalink/ahliterature282360
Source
Ann Rheum Dis. 2016 Oct;75(10):1789-96
Publication Type
Article
Date
Oct-2016
Author
Johan Askling
Niklas Berglind
Stefan Franzen
Thomas Frisell
Christopher Garwood
Jeffrey D Greenberg
Meilien Ho
Marie Holmqvist
Laura Horne
Eisuke Inoue
Kaleb Michaud
Fredrik Nyberg
Dimitrios A Pappas
George Reed
Eiichi Tanaka
Trung N Tran
Suzanne M M Verstappen
Hisashi Yamanaka
Eveline Wesby-van Swaay
Deborah Symmons
Source
Ann Rheum Dis. 2016 Oct;75(10):1789-96
Date
Oct-2016
Language
English
Publication Type
Article
Keywords
Aged
Arthritis, Rheumatoid - complications
Female
Humans
Incidence
Japan - epidemiology
Lymphoma - epidemiology - etiology
Male
Middle Aged
Neoplasms - epidemiology - etiology
North America - epidemiology
Registries - statistics & numerical data
Sweden - epidemiology
United Kingdom - epidemiology
Abstract
The overall incidence of cancer in patients with rheumatoid arthritis (RA) is modestly elevated. The extent to which cancer rates in RA vary across clinical cohorts and patient subsets, as defined by disease activity or treatment is less known but critical for understanding the safety of existing and new antirheumatic therapies. We investigated comparability of, and means to harmonise, malignancy rates in five RA registries from four continents.
Participating RA registries were Consortium of Rheumatology Researchers of North America (CORRONA) (USA), Swedish Rheumatology Quality of Care Register (SRR) (Sweden), Norfolk Arthritis Register (NOAR) (UK), CORRONA International (several countries) and Institute of Rheumatology, Rheumatoid Arthritis (IORRA) (Japan). Within each registry, we analysed a main cohort of all patients with RA from January 2000 to last available data, and sensitivity analyses of sub-cohorts defined by disease activity, treatment change, prior comorbidities and restricted by calendar time or follow-up, respectively. Malignancy rates with 95% CIs were estimated, and standardised for age and sex, based on the distributions from a typical RA clinical trial programme population (fostamatinib).
There was a high consistency in rates for overall malignancy excluding non-melanoma skin cancer (NMSC), for malignant lymphomas, but not for all skin cancers, across registries, in particular following age/sex standardisation. Standardised rates of overall malignancy excluding NMSC varied from 0.56 to 0.87 per 100 person-years. Within each registry, rates were generally consistent across sensitivity analyses, which differed little from the main analysis.
In real-world RA populations, rates of both overall malignancy and of lymphomas are consistent.
PubMed ID
26621482 View in PubMed
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