A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
The association between bacterial infections and the risk of coronary heart disease in type 1 diabetes
Tekijät: Simonsen JR, Järvinen A, Harjutsalo V, Forsblom C, Groop, Lehto M
Kustantaja: WILEY
Julkaisuvuosi: 2020
Journal: Journal of Internal Medicine
Tietokannassa oleva lehden nimi: JOURNAL OF INTERNAL MEDICINE
Lehden akronyymi: J INTERN MED
Vuosikerta: 288
Numero: 6
Aloitussivu: 711
Lopetussivu: 724
Sivujen määrä: 14
ISSN: 0954-6820
eISSN: 1365-2796
DOI: https://doi.org/10.1111/joim.13138
Tiivistelmä
Background Diabetes increases the risk of infections as well as coronary heart disease (CHD). Whether infections increase the risk of CHD and how this applies to individuals with diabetes is unclear.
Objectives To investigate the association between bacterial infections and the risk of CHD in type 1 diabetes. Methods Individuals with type 1 diabetes (n = 3781) were recruited from the Finnish Diabetic Nephropathy Study (FinnDiane), a prospective follow-up study. CHD was defined as incident events: fatal or non-fatal myocardial infarction, coronary artery bypass surgery or percutaneous coronary intervention, identified through national hospital discharge register data. Infections were identified through national register data on all antibiotic purchases from outpatient care. Register data were available from 1.1.1995-31.12.2015. Bacterial lipopolysaccharide (LPS) activity was measured from serum samples at baseline. Data on traditional risk factors for CHD were collected during baseline and consecutive visits.
Results Individuals with an incident CHD event (n = 370) had a higher mean number of antibiotic purchases per follow-up year compared to those without incident CHD (1.34 [95% CI: 1.16-1.52], versus 0.79 [0.76-0.82], P < 0.001), as well as higher levels of LPS activity (0.64 [0.60-0.67], versus 0.58 EU mL-1[0.57-0.59], P < 0.001). In multivariable-adjusted Cox proportional hazards models, the mean number of antibiotic purchases per follow-up year was an independent risk factor for incident CHD (HR 1.21, 95% CI: 1.14-1.29, P < 0.0001). High LPS activity was a risk factor for incident CHD (HR 1.93 [1.34-2.78], P < 0.001) after adjusting for static confounders.
Conclusion Bacterial infections are associated with an increased risk of incident CHD in individuals with type 1 diabetes.
Background Diabetes increases the risk of infections as well as coronary heart disease (CHD). Whether infections increase the risk of CHD and how this applies to individuals with diabetes is unclear.
Objectives To investigate the association between bacterial infections and the risk of CHD in type 1 diabetes. Methods Individuals with type 1 diabetes (n = 3781) were recruited from the Finnish Diabetic Nephropathy Study (FinnDiane), a prospective follow-up study. CHD was defined as incident events: fatal or non-fatal myocardial infarction, coronary artery bypass surgery or percutaneous coronary intervention, identified through national hospital discharge register data. Infections were identified through national register data on all antibiotic purchases from outpatient care. Register data were available from 1.1.1995-31.12.2015. Bacterial lipopolysaccharide (LPS) activity was measured from serum samples at baseline. Data on traditional risk factors for CHD were collected during baseline and consecutive visits.
Results Individuals with an incident CHD event (n = 370) had a higher mean number of antibiotic purchases per follow-up year compared to those without incident CHD (1.34 [95% CI: 1.16-1.52], versus 0.79 [0.76-0.82], P < 0.001), as well as higher levels of LPS activity (0.64 [0.60-0.67], versus 0.58 EU mL-1[0.57-0.59], P < 0.001). In multivariable-adjusted Cox proportional hazards models, the mean number of antibiotic purchases per follow-up year was an independent risk factor for incident CHD (HR 1.21, 95% CI: 1.14-1.29, P < 0.0001). High LPS activity was a risk factor for incident CHD (HR 1.93 [1.34-2.78], P < 0.001) after adjusting for static confounders.
Conclusion Bacterial infections are associated with an increased risk of incident CHD in individuals with type 1 diabetes.
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