Mortality and cardiovascular disease in type 1 and type 2 diabetes
Open accessAbstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.).
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ASCVD is the leading cause of morbidity and mortality in people with diabetes.
“Atherosclerotic cardiovascular disease (ASCVD) broadly refers to a history of acute coronary syndrome, myocardial infarction (MI), stable or unstable angina or coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral artery disease (PAD) including aortic aneurysm and is the leading cause of morbidity and mortality in people with diabetes (1).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [1]
The Discussion (page not provided) reports substantial excess rates of cardiovascular outcomes in people with type 1 or type 2 diabetes, supporting the importance of cardiovascular disease as a source of morbidity and mortality. The paper does not establish that ASCVD is the leading cause, and its Outcomes section (page not provided) does not give the cited sentence’s broad definition of ASCVD. (LLM, conf=0.78)
Experimental — accuracy not yet measuredASCVD is the leading cause of morbidity and mortality in people with diabetes.
“ASCVD broadly refers to a history of acute coronary syndrome, myocardial infarction (MI), stable or unstable angina or coronary or other arterial revascularization, stroke, or peripheral artery disease (PAD) including aortic aneurysm and is the leading cause of morbidity and mortality in people with diabetes (1).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [1]
The Outcomes and Mortality sections assess cardiovascular events and cardiovascular deaths in people with diabetes, supporting the claim that cardiovascular disease contributes to morbidity and mortality. The paper does not establish that ASCVD, specifically, is the leading cause of either, and its cardiovascular outcomes include heart failure rather than being limited to ASCVD. Page numbers are unavailable in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredUnder the current paradigm of comprehensive risk factor modification, cardiovascular morbidity and mortality have notably decreased in people with both type 1 and type 2 diabetes.
“Under the current paradigm of comprehensive risk factor modification, cardiovascular morbidity and mortality have notably decreased in people with both type 1 and type 2 diabetes (1).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [1]
Under the current paradigm of comprehensive risk factor modification, cardiovascular morbidity and mortality have notably decreased in people with both type 1 and type 2 diabetes.
“Under the current paradigm of comprehensive risk factor modification, cardiovascular morbidity and mortality have notably decreased in people with both type 1 and type 2 diabetes (1).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [1]
Type 2 diabetes is common among patients with atherosclerotic cardiovascular disease or at the highest risk of cardiovascular disease, and conversely, atherosclerotic cardiovascular disease is common in patients with type 2 diabetes.
“T2DM is common among patients with ASCVD or at the highest risk of CVD.The converse is also true: ASCVD is common in patients with T2DM.148”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [148]
Diabetes is a well-established risk factor for ischaemic heart disease, and CAD accounts for 40-80% of deaths in patients with T2DM.
“Diabetes is a well-established risk factor for ischaemic heart disease (IHD), and CAD accounts for 40-80% of deaths in patients with T2DM.148,359,381”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [148]
In DAPA-HF, results were consistent across subgroups including those with and without diabetes or CKD.
“These results were consistent across subgroups including those with and without diabetes or CKD.”
From SGLT2 inhibition for CKD and cardiovascular disease in type 2 diabetes: report of a scientific workshop sponsored by the National Kidney Foundation (2021) · cites this paper as [50]
In DAPA-HF, the primary outcome of worsening heart failure or cardiovascular death was significantly reduced, 16.3% versus 21.2% for dapagliflozin compared with placebo (HR 0.74; 95% CI 0.65-0.85).
“The primary outcome of worsening HF or CVD death was significantly reduced, 16.3% versus 21.2% for dapagliflozin compared with placebo (HR, 0.74; 95% CI, 0.65–0.85).”
From SGLT2 inhibition for CKD and cardiovascular disease in type 2 diabetes: report of a scientific workshop sponsored by the National Kidney Foundation (2021) · cites this paper as [50]
Patients with type 2 diabetes are at high risk for atherosclerotic cardiovascular disease and heart failure compared with nondiabetic individuals.
“Patients with T2DM are at high risk for ASCVD and HF compared with nondiabetic individuals (50,53).”
From SGLT2 inhibition for CKD and cardiovascular disease in type 2 diabetes: report of a scientific workshop sponsored by the National Kidney Foundation (2021) · cites this paper as [50]
DAPA-HF was the first clinical trial of an SGLT2 inhibitor to assess heart failure events as the primary outcome and to include participants with and without diabetes.
“DAPA-HF was the first clinical trial of an SGLT2 inhibitor to assess HF events as the primary outcome and to include participants with and without diabetes (50).”
From SGLT2 inhibition for CKD and cardiovascular disease in type 2 diabetes: report of a scientific workshop sponsored by the National Kidney Foundation (2021) · cites this paper as [50]
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Smoking and diabetes: dangerous liaisons and confusing relationships
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Pioglitazone: the forgotten, cost-effective cardioprotective drug for type 2 diabetes
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Evolving Trends in the Epidemiology, Risk Factors, and Prevention of Type 2 Diabetes: A Review
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Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes
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Cardiovascular Risk in Type 1 Diabetes Mellitus
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Current and future therapies for type 1 diabetes
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Time to Recognize HIV Infection as a Major Cardiovascular Risk Factor
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Self-citationType 2 Diabetes: How Much of an Autoimmune Disease?
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Anti-atherosclerotic therapies: Milestones, challenges, and emerging innovations
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Self-citationCardiovascular and Limb Outcomes in Patients With Diabetes and Peripheral Artery Disease
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10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026
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Increased apolipoprotein C3 drives cardiovascular risk in type 1 diabetes
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- Authors
- Rawshani, A., Rawshani, A., Franzén, S., Eliasson, B., Svensson, A.-M., Miftaraj, M., McGuire, D. K., Sattar, N., Rosengren, A., & Gudbjörnsdottir, S.
- Affiliations
- University of Glasgow (GB)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2017-04-13
- Volume
- 376
- Issue
- 15
- Pages
- 1407-1418
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2606281213
- Cited by
- 1,389
- References
- 37
- Citations by year
- 2026: 100 · 2025: 144 · 2024: 163 · 2023: 149 · 2022: 184 · 2021: 176 · 2020: 196 · 2019: 140 · 2018: 95 · 2017: 39
- FWCI
- 101.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 1 diabetes, type 2 diabetes, cardiovascular disease, mortality, coronary artery disease, cardiovascular hospitalization, Sweden, diabetes registry, standardized incidence rate
- MeSH terms
- Adolescent, Adult, Aged, Cardiovascular Diseases, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Hospitalization, Humans, Male, Middle Aged, Mortality, Registries, Risk Factors, Sweden, Incidence, Proportional Hazards Models, Age of Onset
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