Diabetes and risk of cardiovascular disease

From an interesting study about a subject I’ve wondered about from time to time:

“OBJECTIVE—To compare the risk of cardiovascular disease (CVD) death and the impact of hyperglycemia on the risk of CVD mortality associated with type 1 diabetes to that associated with type 2 diabetes.

RESULTS—During an 18-year follow-up, 86 participants with type 1 diabetes, 567 participants with type 2 diabetes, and 252 nondiabetic participants died. CVD mortality rates per 1,000 person-years were 23.1 (95% CI 16.9–31.9) in type 1 diabetic, 35.3 (30.8–40.4) in type 2 diabetic, and 4.6 (3.8–5.7) in nondiabetic participants. Adjusted hazard ratios for CVD mortality in participants with type 1 diabetes versus no diabetes was 3.6 (95% CI 2.2–5.7) in men and 13.3 (6.9–22.5) in women and in participants with type 2 diabetes versus no diabetes 3.3 (2.5–4.5) in men and 10.1 (6.7–17.4) in women. An increment of 1 unit (%) of GHb increased CVD mortality by 52.5% (95% CI 28.4–81.3) in type 1 diabetic subjects and by 7.5% (4.3–10.8) in type 2 diabetic participants.

CONCLUSIONS—The impact of type 1 and type 2 diabetes on CVD mortality was similar. The effect of increasing hyperglycemia on the risk of CVD mortality was more profound in type 1 than in type 2 diabetic subjects.”

Do note that the age of onset of diabetes was >30 years in both groups, so the relevance of the results when it comes to my own situation (diagnosis at the age of 2) is still questionable. Of course this is only speculation on my part, but one reason I can think of why the impact of hyperglycemia is ‘more profound in type 1’ patients might be that type 2 diabetics already have a lot of risk factors (obesity, ‘life style’, ect.), so that the effect of one more risk factor mean marginally less than it does among type 1 patients. If you’re already fat and sedentary and have been for many years, which most type 2 patients statistically are, adding hyperglycemia will not impact your risk of CVD-risk much, as it’s probably already through the roof; if you’re a sedentary type 2 diabetic with a BMI > 30 who also smokes daily, we’re not talking about the likelihood of dying from CVD, we’re only talking about when it’ll happen.

The part below is a good way to illustrate that the two diseases, type 1 and type 2 diabetes, are not all that similar, or at least that the patients are not all that similar:

“At baseline type 1 diabetic participants, when compared with nondiabetic participants, were leaner and had higher HDL cholesterol and lower diastolic blood pressure, but they had a slightly higher prevalence of hypertension, higher systolic blood pressure, and higher content of urinary protein than nondiabetic participants. Type 2 diabetic participants, when compared with nondiabetic participants were older, heavier, and more often nonusers of alcohol and had a higher frequency of hypertension, higher systolic and diastolic blood pressure, lower HDL cholesterol, higher triglycerides, higher content of urinary protein, and higher estimated creatinine clearance. Type 1 diabetic participants, when compared with type 2 diabetic participants were younger, leaner, and less frequently nonusers of alcohol and had lower prevalence of hypertension, lower diastolic and systolic blood pressure, higher HDL cholesterol, lower triglycerides, longer duration of diabetes, and lower estimated creatinine clearance.”

Some of these differences are probably sample-related, but not all of them. Note that despite being leaner and having more of the ‘good cholesterol’, type 1 diabetics still had worse kidney function than ‘healthy people’. That kidney damage is disease-related, not life-style related, and it’s quite likely that the patients had higher HDL cholesterol (and were leaner?) because they on average eat (live?) healthier than people who aren’t sick – that’s after all what they’re supposed to do. The ‘diabetic = fat guy who asked for it’ heuristic doesn’t work when we’re talking about the type 1s.


August 7, 2010 Posted by | Cardiology, Diabetes, Medicine, Nephrology, Studies | Leave a comment

Interesting Times

I’ve finished Equal Rites and have begun (well, I’ve read half of it, but…) Interesting Times, also by Pratchett. A very funny book.

Part of what makes Pratchett’s books so good is his choice of ‘heroes’. Forget about the ‘standard hero’, I’ve read four of his novels so far and the main characters were: 1-2) a (former?) con man, thief ect. 3) a somewhat old, cowardly, completely unskilled wizard who pretty much can’t do any magic, 4) a small girl wizard and an old witch. Of course it also comes down to this whole wonderful universe he’s created for the characters to inhabit.

Some quotes from the book:

“‘Them? I didn’t know they were noble,’ said Io.
‘They’re all very rich and have had millions of people butchered or tortured to death merely for reasons of expediency and pride,’ said the Lady.
The watching gods nodded solemnly. That was certainly noble behaviour. That was exactly what they would have done.”

“It was crowded. The air shimmered over the braziers of chestnut sellers and hot potato merchants and echoed with the traditional street cries of Old Ankh-Morpork.*
… *Such as ‘Ouch!’, ‘Aargh!’, ‘Give me back my money, you scoundrel!’ and ‘You call these chestnuts? I call them little balls of charcoal, that’s what I call them!'”

“Very peaceful place, the Agatean Empire,’ said Ridcully. ‘Very tranquil. Very cultured. They set great store in politeness.’
‘Well, yes,’ said the Lecturer in Recent Runes, ‘I heard it was because people who aren’t tranquil and quiet get serious bits cut off, don’t they? I heard the Empire has a tyrannical and repressive government!’
‘What form of government is that?’ said Ponder Stibbons.
‘A tautology,’ said the Dean, from above” [‘above’ refers to the fact that the Dean refused to come down from the chandelier when the meeting started and is still occupying it at this point]

“Rincewind looked longingly towards the door. It was no distance at all for the experienced coward.”

“The choices seemed very clear to Rincewind. There was the city of Hunghung, under siege, apparently throbbing with revolution and danger, and there was everywhere else.
Therefore it was important to know where Hunghung was so that he didn’t blunder into it by accident. He paid a lot of attention to Mr Saveloy’s instructions, and then rode the other way.”

“‘What happens if I claim immunity because I’m a foreigner?’
‘There’s a special thing they do with a wire-mesh waistcoat and a cheesegrater.’
‘And there are torturers in Hunghung who can keep a man alive for years.’
‘I suppose you’re not talking about healthy early morning runs and a high-fibre diet?’
‘No. So keep quiet and with any luck you’ll be sent to be a slave in the palace.’
‘Luck is my middle name,’ said Rincewind, indistinctly. ‘Mind you, my first name is Bad.’

‘What? But he’s a tax collector! That’s what they’re for!’
‘A firm tax base is the foundation of sound governance, gentlemen. Please trust me.’
‘I understood all of that up to “A firm tax”.’
‘Nevertheless, no useful purpose will be served by killing this hard-working tax gatherer.’
‘He’d be dead. I call that useful.’

August 7, 2010 Posted by | Books, Terry Pratchett | Leave a comment