Mortality in People with Diabetes Causes of Death

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Mortality in People with DiabetesCauses of Death
of Deaths
Ischemicheartdisease
Otherheartdisease
Diabetes
Cancer
Stroke
Infection
Other
Geiss LS et al. In Diabetes in America. 2nd ed.
1995 chap 11.
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Variation in mortality for CHD in USA Gu K, et
al. JAMA, 2811291-1297,1999
Mortalità per cardiopatia coronarica ()
Non diabetici
Diabetici
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Age-Specific Prevalence of the metabolic syndrome
among 8814 US adults aged at least 20 years, by
sex, National Health and Nutrition Examination
Survey III, 1988-1994
Prevalence
Age (years)
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Prevalence of insulin resistance with associated
metabolic disorders
100
80
60
Prevalence of HOMA insulinresistance ()
40
20
0
0
1
2
3
4
Number of metabolic disorders
Metabolic disorders glucose intolerance,
dyslipidaemia, hyperuricaemia and/or
hypertensionplt0.001 for differences in
prevalence rates across categories
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ATP III Framingham Risk Scoring
Nota Le stime del rischio sono state derivate
dallesperienza del Framingham Heart Study, con
una popolazione di razza predominante Caucasica
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Prevalence of asyntomatic CHD
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Incidenza di infarto fatale e non fatale in
relazione a eventuale pregresso infarto
East-West Study Follow-up a 7 anni
50
45.0
40
plt0.001
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Incidenza durante il follow-up ()
20.2
18.8
20
plt0.001
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3.5
0
(n69)
(n1304)
(n169)
(n890)
Eventi per100 persone-anno
3.0
0.5
7.8
3.2
Haffner SM et al. N Engl J Med 1998339229-234.
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CAPRIE steering Committee. A randomised, blinded.
Trial of clopidogrel versus aspirin in patients
at risk of ischaemic events Lancet 1996
3481329-1339
Aronow WS, Ahn C. Prevalence of coexistence of
coronary artery disease, peripheral arterial
disease, and atherothrombotic brain infarction in
men and women lt62 years of age. Am J Cardiol
1994 74 64-65
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Incidenza di ictus fatale e non fatale in
relazione a eventuale pregresso infarto
Follow-up a 7 anni East-West Study
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19.5
20
plt0.001
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Incidenza durante il follow-up ()
10.3
10
7.2
p0.01
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1.9
0
(n69)
(n1304)
(n169)
(n890)
Eventi per100 persone-anno
1.2
0.3
3.4
1.6
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High cardiovascular disease mortality in subjects
with visual impairment caused by diabetic
retinopathy (Rajala U et al, Diabetes Care 23
957-961,2000)
Cumulative survival after 4 years
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Complicanze CHD4.280 visite a diabetici
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The Metabolic Syndrome NCEP classification

• Abdominal Obesity waist gt102 cm in M and gt88 cm
  in F
• Triglycerides ?150 mg/dl
• HDLlt40 mg/dl in M and lt50 mg/dl in F
• PA ?130/85 mm Hg
• FPG ?110 mg/dl

(National Cholesterol Education Program-NCEP-III
Report. JAMA 16 285 (5) 2001).
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The Aims

• How each component of the Metabolic Syndrome
  aggregate in Type 2 diabetes?
• Do components of the Metabolic Syndrome
  significantly associate with prevalent coronary
  artery disease in Type 2 diabetes?

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DAI STUDY The Metabolic Syndrome (1)
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DAI STUDY The Metabolic Syndrome (2)
Percentage of patients
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DAI STUDY The Metabolic Syndrome (3). Prevalence
of the components segregating with type 2 diabetes
Percentage
Number of Metabolic Abnormalities
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DAI STUDY The Metabolic Syndrome (4). Prevalence
of a single component
Percentage
Metabolic Abnormalities
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The presence of CHD was assessed as follows

• A positive history for hospital admission for
  either an acute myocardial infarction (AMI) or an
  episode of angina
• A positive 12-lead ECG for prior acute myocardial
  infarction or angina coded using the Minnesota
  coding system (criteria I 1-3, IV 1-3, V 1-2, and
  VII 1)
• A positive history for coronary artery by-pass
  graft (CABG)
• A positive history for percutaneous transluminal
  coronary angioplasty (PTCA).

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Logistic analysis of the variables associated to
CHD in type 2 diabetic patients in Italy
Odd ratio
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Steno 2 Conclusions
Taken together, these data suggest that a
long-term, targeted, intensive intervention
involving multiple risk factors reduces the risk
of both cardiovascular and microvascular events
by about 50 per cent among patients with type 2
diabetes and microalbuminuria
NEJM 2003 348 383-93