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. 2024 Sep 3:16:571-585.
doi: 10.2147/CLEP.S463363. eCollection 2024.

Causes of Excess Mortality in Diabetes Patients Without Coronary Artery Disease: A Cohort Study Revealing Endocrinologic Contributions

Guilian Birindwa  1   2 , Michael Maeng  1   3 , Pernille Gro Thrane  1 , Christine Gyldenkerne  1   2 , Reimar Wernich Thomsen  2 , Kevin Kris Warnakula Olesen  1
Affiliations

Causes of Excess Mortality in Diabetes Patients Without Coronary Artery Disease: A Cohort Study Revealing Endocrinologic Contributions

Guilian Birindwa et al. Clin Epidemiol. .

Abstract

Background: Diabetes mellitus (DM) patients without coronary artery disease (CAD) have a higher all-cause mortality rate than patients with neither DM nor CAD. We examined cause-specific death of DM patients with and without CAD.

Methods: We conducted a cohort study of all patients who underwent CAG in Western Denmark between 2003 and 2016. Using Danish health registries, patients were followed for a maximum of 10 years and stratified according to their DM and CAD status. Outcomes included all-cause-, cancer-, circulatory-, and endocrinologic death. Ten-year cumulative risks were computed as well as adjusted and unadjusted hazard ratios (aHR and HR).

Results: A total of 132,432 patients (28,524 deaths, median follow-up of 6.2 years) were included. Compared to patients with neither DM nor CAD, DM patients without CAD had a higher 10-year risk of all-cause death (27.9% versus 19.7%, aHR 1.43 [95% CI 1.35-1.52]), cancer death (7.2% versus 5.4%, aHR 1.29 [95% CI 1.15-1.46]), circulatory death (9.1% versus 6.9%, aHR 1.35 [95% CI 1.22-1.49]), and endocrinologic death (3.9% versus 0.3%, aHR 14.02 [95% CI 10.95-17.95]). Among endocrinologic deaths, 87% were due to classical complications of DM, such as diabetic nephropathy and ketoacidosis, in DM patients without CAD.

Conclusion: Diabetes patients without CAD exhibit a higher risk of all-cause mortality, driven primarily by elevated rates of cancer, circulatory, and endocrinologic deaths, particularly related to diabetic microvascular complications.

Keywords: coronary artery disease; death; diabetes.

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Conflict of interest statement

MM is supported by a grant from the Novo Nordisk Foundation (grant number NNF22OC0074083); has received institutional research grants from Bayer and Novo Nordisk; and has received lecture and/or advisory board fees from AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, and Novo Nordisk. He also has an institutional research contract with Philips and Janssen and reports equity interests from Eli Lilly and Verve Therapeutics. KWO has received a research grant from the Danish Cardiovascular Academy. All other authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Patient selection. CAD: coronary artery disease; DM: diabetes mellitus.
Figure 2
Figure 2
Cumulative incidences rate curves of all-cause death, cancer death, circulatory death, and endocrinologic death in patients with and without diabetes mellitus (DM), stratified by the presence or absence of coronary artery disease (CAD).
Figure 3
Figure 3
Hazard ratio of cause-specific death in diabetes patients without coronary artery disease compared with patients with neither diabetes nor coronary artery disease. HR indicates hazard ratio. Size of dot indicates the weight of the cause-specific death compared to all-cause death.
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