title: Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes.
abstract: Long-term trends in excess risk of death and cardiovascular outcomes have not been extensively studied in persons with type 1 diabetes or type 2 diabetes.
  
  
  
  We included patients registered in the Swedish National Diabetes Register from 1998 through 2012 and followed them through 2014. Trends in deaths and cardiovascular events were estimated with Cox regression and standardized incidence rates. For each patient, controls who were matched for age, sex, and county were randomly selected from the general population.
  
  
  
  Among patients with type 1 diabetes, absolute changes during the study period in the incidence rates of sentinel outcomes per 10,000 person-years were as follows: death from any cause, -31.4 (95% confidence interval [CI], -56.1 to -6.7); death from cardiovascular disease, -26.0 (95% CI, -42.6 to -9.4); death from coronary heart disease, -21.7 (95% CI, -37.1 to -6.4); and hospitalization for cardiovascular disease, -45.7 (95% CI, -71.4 to -20.1). Absolute changes per 10,000 person-years among patients with type 2 diabetes were as follows: death from any cause, -69.6 (95% CI, -95.9 to -43.2); death from cardiovascular disease, -110.0 (95% CI, -128.9 to -91.1); death from coronary heart disease, -91.9 (95% CI, -108.9 to -75.0); and hospitalization for cardiovascular disease, -203.6 (95% CI, -230.9 to -176.3). Patients with type 1 diabetes had roughly 40% greater reduction in cardiovascular outcomes than controls, and patients with type 2 diabetes had roughly 20% greater reduction than controls. Reductions in fatal outcomes were similar in patients with type 1 diabetes and controls, whereas patients with type 2 diabetes had smaller reductions in fatal outcomes than controls.
  
  
  
  In Sweden from 1998 through 2014, mortality and the incidence of cardiovascular outcomes declined substantially among persons with diabetes, although fatal outcomes declined less among those with type 2 diabetes than among controls. (Funded by the Swedish Association of Local Authorities and Regions and others.).
authors.affiliation: From the Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, Sweden; the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.); and the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.).
authors.forename: Aidin
authors.initials: A
authors.lastname: Rawshani
authors.affiliation: From the Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, Sweden; the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.); and the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.).
authors.forename: Araz
authors.initials: A
authors.lastname: Rawshani
authors.affiliation: From the Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, Sweden; the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.); and the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.).
authors.forename: Stefan
authors.initials: S
authors.lastname: Franzén
authors.affiliation: From the Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, Sweden; the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.); and the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.).
authors.forename: Björn
authors.initials: B
authors.lastname: Eliasson
authors.affiliation: From the Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, Sweden; the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.); and the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.).
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Svensson
authors.affiliation: From the Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, Sweden; the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.); and the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.).
authors.forename: Mervete
authors.initials: M
authors.lastname: Miftaraj
authors.affiliation: From the Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, Sweden; the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.); and the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.).
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.affiliation: From the Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, Sweden; the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.); and the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.).
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.affiliation: From the Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, Sweden; the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.); and the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.).
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.affiliation: From the Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, Sweden; the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.); and the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.).
authors.forename: Soffia
authors.initials: S
authors.lastname: Gudbjörnsdottir
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology