Wang, Shu-Li; (1995) Cardiovascular disease mortality and its risk factors among diabetic patients - A multinational approach. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This dissertation reports on the follow-up of a cohort of 4740 patients with diabetes mellitus from ten centres in 9 countries (London, Switzerland, Warsaw, Berlin, Zagreb, Hongkong Tokyo, Havana, Oklahoma and Arizona). The patients were between 35 and 54 years old in 1975-77; in each centre the study sample was stratified by age, gender and diabetes duration. Patients with Insulin Dependent Diabetes Mellitus (IDDM) and Non-Insulin Dependent Diabetes Mellitus (NIDDM) were included. Subjects were followed for mortality up to 31.7.1987. Underlying causes of death were determined from the assessment of death certificates and other medical records. Baseline risk factors for mortality were examined, including the putative risk factors for cardiovascular disease. The three main causes of death for 1088 deceased patients (367 of whom had IDDM and 721 of whom had NIDDM) were cardiovascular disease (48%), malignant neoplasms (13%) and diabetes mellitus (13%). Standardised Mortality Ratios (SMR) when compared with the respective general populations was high for cardiovascular disease and low for cancer. Age-adjusted mortality rates were higher for ischaemic heart disease than for cerebrovascular disease in both types of diabetes. The study has allowed us to make comparisons of cardiovascular mortality between countries with sufficient numbers of observations and using standardised methods. The highest survival rates over the follow-up period were found in Tokyo for NIDDM patients and in London for IDDM patients. The baseline variables most consistently linked with cardiovascular mortality were elevated blood pressure, proteinuria and ECG abnormality. Higher SMRs than expected suggested an interactive effect of proteinuria and hypertension on mortality. Diabetes duration and body mass index had a relatively weak relationship with cardiovascular mortality. Key words: Epidemiology, Mortality, Diabetes mellitus, Diabetic complication. Cardiovascular disease.

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