Format

Send to

Choose Destination
Diabetes Care. 2017 Dec;40(12):1763-1770. doi: 10.2337/dc17-1091. Epub 2017 Oct 6.

Causes of Death in a Contemporary Cohort of Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease: Insights From the TECOS Trial.

Author information

1
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC a.sharma@duke.edu.
2
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
3
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
4
University of North Carolina School of Medicine, Chapel Hill, NC.
5
George Washington University Biostatistics Center, Rockville, MD.
6
University of Leuven, Leuven, Belgium.
7
Merck & Co., Inc., Kenilworth, NJ.
8
Munich Diabetes Research Group, Helmholtz Centre, Neuherberg, Germany.
9
Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong.
10
Centre for Diabetes and Endocrinology, Johannesburg, South Africa.
11
Don Beaven Medical Research Centre, Christchurch Hospital, Christchurch, New Zealand.
12
Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K.

Abstract

OBJECTIVE:

We evaluated the specific causes of death and their associated risk factors in a contemporary cohort of patients with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD).

RESEARCH DESIGN AND METHODS:

We used data from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study (n = 14,671), a cardiovascular (CV) safety trial adding sitagliptin versus placebo to usual care in patients with type 2 diabetes and ASCVD (median follow-up 3 years). An independent committee blinded to treatment assignment adjudicated each cause of death. Cox proportional hazards models were used to identify risk factors associated with each outcome.

RESULTS:

A total of 1,084 deaths were adjudicated as the following: 530 CV (1.2/100 patient-years [PY], 49% of deaths), 338 non-CV (0.77/100 PY, 31% of deaths), and 216 unknown (0.49/100 PY, 20% of deaths). The most common CV death was sudden death (n = 145, 27% of CV death) followed by acute myocardial infarction (MI)/stroke (n = 113 [MI n = 48, stroke n = 65], 21% of CV death) and heart failure (HF) (n = 63, 12% of CV death). The most common non-CV death was malignancy (n = 154, 46% of non-CV death). The risk of specific CV death subcategories was lower among patients with no baseline history of HF, including sudden death (hazard ratio [HR] 0.4; P = 0.0036), MI/stroke death (HR 0.47; P = 0.049), and HF death (HR 0.29; P = 0.0057).

CONCLUSIONS:

In this analysis of a contemporary cohort of patients with diabetes and ASCVD, sudden death was the most common subcategory of CV death. HF prevention may represent an avenue to reduce the risk of specific CV death subcategories.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00790205.

PMID:
28986504
DOI:
10.2337/dc17-1091
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center