Study on Cardiovascular Disease and Lower-Limb Amputation in Type 1 Diabetes

France: Cardiovascular disease (CVD) and lower-limb amputation (LLA) have a similar and heavy burden in people with long-standing type 1 diabetes (T1D), claims a recent study in Cardiovascular Diabetology. Each of the conditions singly raises the risk of all-cause death to two-folds, with an additive effect. The presence of both LLA and CVD at baseline was tied to excess death risk, five times higher than in the absence of these conditions.

"Our findings encourage careful consideration of patients with T1D and LLA as usually recommended for those with CVD, in terms of treatment, prevention, and management of risk factors," Kamel Mohammedi, Faculty of Medicine, University of Bordeaux, Bordeaux, France, and colleagues wrote in their study.

Cardiovascular disease and nontraumatic lower-limb amputation each result in reduced life expectancy in type 1 diabetes patients, but the differential burden between these conditions is not known. Considering this, Dr. Mohammedi and the team compared the effects of CVD and LLA on mortality risk in patients with type 1 diabetes.

For this purpose, they used pooled data from the SURGENE, GENEDIAB, and GENESIS prospective cohorts. Data was categorized into:

• Absence of CVD (myocardial infarction and/or stroke) nor LLA
• History of CVD alone without LLA
• LLA alone without CVD
• Both conditions at baseline

Patients with baseline history of peripheral artery disease were excluded from groups 1 and 2. Any death occurring during the follow-up regardless of the causes was the study endpoint.

Findings

• Among 1169 participants (male 55%, age 40 ± 13 years, diabetes duration 23 ± 11 years), CVD, LLA, or both were present at baseline in 4.2%, 5.3%, and 1.7% of subjects, respectively.
• All-cause death occurred in 26% of participants during a 17-year follow-up, corresponding to 18,426 person-years and an incidence rate of 16 per 1000 person-years.
• The risk of death increased in individuals with a baseline history of CVD (adjusted HR 2.00) or LLA (2.26), versus no condition, with an additive effect in people with both conditions (5.32).
• No incremental risk of death was observed in people with CVD versus LLA (0.87).
• Compared with no condition, CVD and LLA were similarly associated with reduced life expectancy during follow-up: 2.79 and 3.38 years, respectively.
• Combined conditions expose to 7.04 fewer years of life expectancy.

To conclude, "CVD and LLA conferred a similar burden regarding mortality in type 1 diabetes patients. The findings encourage a careful consideration of people with type 1 diabetes and LLA as usually recommended for those with CVD, in terms of management of risk factors, treatments, and prevention."

Reference

Camoin, M., Velho, G., Saulnier, PJ. et al. Differential prognostic burden of cardiovascular disease and lower-limb amputation on the risk of all-cause death in people with long-standing type 1 diabetes. Cardiovasc Diabetol 21, 71 (2022). https://doi.org/10.1186/s12933-022-01487-8