Apolipoprotein B as a long-term predictor of mortality in type 1 diabetes mellitus: a 15-year follow up.
OBJECTIVE
To evaluate the association of apolipoprotein B (apo B) with mortality due to all causes, to cardiac disease and to ischaemic heart disease (IHD) in subjects with type 1 diabetes mellitus.


METHODS
165 subjects with type 1 diabetes included in the Swiss Cohort of the WHO Multinational Study of Vascular Disease in Diabetes were followed for 14.7+/-0.45 years.


METHODS
Causes of death were obtained from death certificates, hospital records and postmortem reports. Using a parametric proportional hazards model the association of apo B with mortality rates was assessed by time-to-event analysis, including the absolute cumulative mortality risk over time for various apo B levels at baseline.


RESULTS
Apo B was positively associated with all-cause mortality [hazard ratio (HR) 2.65 per g L-1 increase of apo B, 95% CI: 1.11-6.36, P=0.029], cardiac mortality (HR 11.64, 1.03-131.11, P=0.047) and IHD mortality (HR 9.36, 1.26-69.66, P=0.029). An apo B>or=0.96 g L-1 translated into a duplication of overall mortality hazard (HR 1.93, 1.00-3.72, P=0.050), and a sevenfold increase of mortality because of cardiac disease or IHD (HR 7.44, 1.44-38.42, P=0.017 and HR 7.38, 0.78-69.82, P=0.081). A baseline apo B of 1.5 g L-1 predicted an absolute cumulative risk to die over the next 10 years of 12.1% (5.2-31.7) for male and of 10.4% (4.7-26.1) for female subjects whereas risks were 6.3% (1.8-21.4) and 5.4% (0.8-15.8) for an apo B of 0.8 g L-1.


CONCLUSIONS
Apo B is consistently associated with an increased mortality in type 1 diabetes.
Stettler
C
C
Division of Endocrinology and Diabetes, Department of Social and Preventive Medicine, University of Bern, Bern, Switzerland. christoph.stettler@insel.ch
Suter
Y
Y
Allemann
S
S
Zwahlen
M
M
Christ
E R
ER
Diem
P
P
D001055:Apolipoproteins B / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000401:mortality; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D016019:Survival Analysis
D001055:Apolipoproteins B; D015415:Biomarkers