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CVD the leading cause of death in patients with type 2 diabetes

Cardiovascular disease (CVD) was the leading cause of death among the over 16,000 patients with type 2 diabetes (T2DM) who were enrolled in the SAVOR-TIMI 53 trial. Two-thirds (66.3%) of all 798 deaths after a median 2.1 years of follow-up were caused by one of five cardiovascular (CV) conditions, with sudden cardiac death accounting for the largest share (30.1%) of the total, Dr Ilaria Cavallari, and associates at the University Campus Bio-Medico of Rome, Italy said.

Most common among the non-CV causes was malignancy at 13.9% of all deaths in a T2DM population at high/very high risk for CV disease (n = 16,492), followed by infection (9.3%), the members of the TIMI Study Group noted.

After variables independently associated with overall mortality were identified, a sub-distribution of competing risks was constructed using a competing-risk analysis based on the proportional hazards model, they explained.

Prior heart failure was the clinical variable most associated with CV death and could, along with older age, worse glycaemic control, prior CV events, peripheral artery disease, and kidney complications, "identify a subgroup of T2DM patients at high risk of mortality who are likely to achieve the greatest benefit from aggressive management of modifiable risk factors and newer glucose-lowering agents," the investigators wrote.

It was a pair of laboratory measurements, however, that had the largest sub-distribution hazard ratios. "Interestingly, the magnitude of associations of abnormal N-terminal pro–B-type natriuretic peptide (sHR, 2.82) and high-sensitivity troponin T (sHR, 2.46) measured in a stable population were greater than clinical variables in the prediction of all causes of death," Cavallari and associates said.

 

Study details
Causes and Risk Factors for Death in Diabetes: A Competing-Risk Analysis From the SAVOR-TIMI 53 Trial

IlariaCavallari, Deepak L.Bhatt, GabrielSteg, Lawrence ALeiter, Darren K McGuire, Ofri Mosenzon, Kyungah Im, Itamar Raz, Eugene Braunwald, Benjamin M Scirica

Published in the Journal of the American College of Cardiology on 5 April 2021

 

Journal of the American College of Cardiology letter (Restricted access)

 

See also MedicalBrief archives:

More years of obesity means higher risk of cardiometabolic disease

Fat mass index, not BMI, associated with CVD events in people with diabetes

Risks of CVD and metabolic disorders higher for stigmatised obese

Severe obesity — a standout risk for heart failure

Abdominal fat and cardiovascular disease risk – NHLBI study

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