Transcript Data on CVD and diabetes by Kathleen Bennett - Dynamo-Hia

Work Package 9
Cardiovascular disease (CVD)
and diabetes
K Bennett, B McGowan, Trinity College, Dublin, Ireland
Collaborators: S. Capewell, Liverpool University, UK
J. Critchley, Newcastle University, UK.
Relevance of the diseases
• Coronary heart disease (CHD) remains the single most
common cause of deaths in the EU, but there has been
a reduction in the crude number of deaths over recent
years.
• This reflects a general trend in Western, Northern and
Southern European countries, where CHD mortality,
incidence and case fatality rates are falling steadily. The
situation in some Central and Eastern European
countries is different with CHD rates rising.
• This gradient is more marked for stroke mortality where
the number of deaths has been increasing and over
200,000 men and 300,000 women die of stroke in the
EU each year.
• Over 48 million adults in Europe and 23 million in EU
have diabetes and the prevalence is increasing.
Definitions of disease
EUROCISS Recommendations
AMI: ICD10 codes I20-I21 (ICD9: 410)
IHD: ICD10 codes I20-I25 (ICD9: 410-414)
CVA : ICD10 codes I60-I69 (ICD9: 430-438)
Ischaemic STROKE : ICD10 code I64 (ICD9: 434)
Haemorragic STROKE :
(Intracerebral) ICD10 codes I61, I62 (ICD9: 431, 432)
(Subarachnoid) ICD10 code I60 (ICD9: 430)
Diabetes: ICD10 code E10-E14. (ICD9: 250)
Disease information in Dynamo
• Consistent incidence, prevalence and mortality
rates (numbers of deaths) for Ischaemic Heart
Disease (IHD), stroke and diabetes, including
case fatality rates where available
• For 27 EU countries; period 2000-2006, by
gender and age (all ages considered)
– Most data available by 5 or 10 year agebands, so
extrapolation to single years required.
• Some countries have little information available
– For morbidity data : Bulgaria, Estonia, Greece,
Hungary, Luxembourg, Malta, Poland and Romania.
– For mortality data: Belgium, Cyprus and (Italy and
Portugal from 2003).
Diabetes and CVD: RR
AMI:
• INTERHEART study: (Yusuf et al) Case-control study of 15,000 cases (AMI) and controls
in 52 countries.
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Men <=55 yrs RR=2.66 (2.04,3.46), >55yrs RR=1.93 (1.58,2.37); women <=55 yrs RR=3.53
(2.49,5.01), >55 yrs RR=2.59 (1.78,3.78)
CVD/CHD:
• Euroaspire I: In multivariate analysis, smoking and diabetes emerged as the strongest
predictors of CVD [risk ratios (RR)2.2 and 2.5 respectively] and CHD mortality (RR 2.4 and
2.4 respectively).
• Framingham heart study: The relative odds of CVD increased 1.39-fold (95% confidence
interval 1.06-1.83) for increases in HbA1c of 1% (e.g., for HbA1c from 5 to 6%).
• Meta-analysis of prospective cohort studies. The overall summary relative risk for fatal
coronary heart disease in patients with diabetes compared with no diabetes was
significantly greater among women than it was among men: 3.50, 95% confidence interval
2.70 to 4.53 v 2.06, 1.81 to 2.34
Stroke:
• Nurses Health Study: the incidence of total stroke was twofold higher among women with
type 2 diabetes (1.8 [1.7–2.0]) than for nondiabetic women. The multivariate RR of
ischemic stroke was increased twofold (2.3 [2.0 –2.6]) in type 2 diabetes.
• Asia Pacific Studies Collaboration
• UKPDS risk engine http://www.dtu.ox.ac.uk/index.php?maindoc=/riskengine/
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provides risk estimates and 95% confidence intervals, in individuals with type 2 diabetes not known
to have heart disease, for:
non-fatal and fatal coronary heart disease
fatal coronary heart disease
non-fatal and fatal stroke
fatal stroke
Main data sources
• Mortality
– WHO HFA database
– WHOSIS (WHO Statistical Information System)
• an online database of the most recent and comprehensive health information on
all of the 193 WHO Member States.
– OECD
• Some health data by overall figures, not by age/sex
• Morbidity (prevalence/incidence)
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WHO HFA database
EUROSTAT;
OECD, MONICA (historical data), EUROCISS sources
International Diabetes Federation – Diabetes Atlas
Extrapolation from incidence/mortality; DISMOD II
• Case Fatality
– OECD, EUROCISS sources
– MONICA (historical data)
• Local data sources
– E.g. Danish National patient register and the Danish National death certificate
registers have provided data.