title: Severe hypoglycemia and mortality after cardiovascular events for type 1 diabetic patients in Sweden.
abstract: OBJECTIVE
  To examine whether previous severe hypoglycemic events were associated with the risk of all-cause mortality after major cardiovascular events (myocardial infarction [MI] or stroke) in patients with type 1 diabetes.
  
  
  METHODS
  This study is based on data from the Swedish National Diabetes Register linked to patient-level hospital records, prescription data, and death records. We selected patients with type 1 diabetes who visited a clinic during 2002-2010 and experienced a major cardiovascular complication after their clinic visit. We estimated a two-part model for all-cause mortality after a major cardiovascular event: logistic regression for death within the first month and a Cox proportional hazards model conditional on 1-month survival. At age 60 years, 5-year cumulative mortality risk was estimated from the models for patients with and without prior diabetes complications.
  
  
  RESULTS
  A total of 1,839 patients experienced major cardiovascular events, of whom 403 had previously experienced severe hypoglycemic events and 703 died within our study period. A prior hypoglycemic event was associated with a significant increase in mortality after a cardiovascular event, with hazard ratios estimated at 1.79 (95% CI 1.37-2.35) within the first month and 1.25 (95% CI 1.02-1.53) after 1 month. Patients with prior hypoglycemia had an estimated 5-year cumulative mortality risk of 52.4% (95% CI 45.3-59.5) and 39.8% (95% CI 33.4-46.3) for MI and stroke, respectively.
  
  
  CONCLUSIONS
  We have found evidence that patients with type 1 diabetes in Sweden with prior severe hypoglycemic events have increased risk of mortality after a cardiovascular event.
authors.affiliation: Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Australia tom.lung@unimelb.edu.au.
authors.forename: Tom W C
authors.initials: TW
authors.lastname: Lung
authors.affiliation: Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Dennis
authors.initials: D
authors.lastname: Petrie
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.affiliation: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Palmer
authors.affiliation: Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Svensson
authors.affiliation: Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Eliasson
authors.affiliation: Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Clarke
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000150:complications* / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D012306:Risk; D020521:Stroke / Q000453:epidemiology / Q000401:mortality; D013548:Sweden / Q000453:epidemiology