Résumé
The association between diabetes and cardiovascular diseases is well established, as still the main cause of death among these patients. We followed a cohort of 703 high risk type 2 diabetic patients during a median follow up of 5,8 years and thought to determine predictive factors associated with mortality and cardiovascular mortality.
Survival analysis was made. For univariate analysis, we used Kaplan Meyer methods. Covariables with p-value < 0.15 at log-rank test were introduced in COX multivariate analysis. Significant variables were selectioned for final model selection through STEPWISE, BACKWARD, FORWARD methods.
Among these patients, 58% were male, mean age of 62,06 years, with a mean length of diabetes of 13,80 years and a HbA1c of 8,35%. 29% had positive microalbuminuria or proteinuria, 14% had a creatinin clearance inferior to 60ml/min. 12% had obliterating arteriopathy of the lower limbs definied by pulse abolition. Mean LDL was 1,10g/l, 54% of these patients were under statin treatment. 60% were classified as having hypertension, and 43% were currents somokers. During follow up, 67 patients died (9,5%) with mainly cardiovascular death (57 patients). In multivariate analysis, obliterating arteriopathy of the lower limbs, insulin treatment, antiagregant treatment, triglyceride level above 1,5g/l were associated with global mortality. Regarding predictive factors associated with cardiovascular mortality, we found that obliterating arteriopathy of the lower limbs, creatinin clearance under 60ml/min and high systolic blood pressure were associated. Obliterating arteriopathy of the lower limbs was the strongest predictor of mortality (RR=2,68; IC95%:1,58-4,52) and of cardiovascular mortality (RR=2,79; IC95%:1,68-4,64).
Presence of obliterating arteriopathy of the lower limbs diagnosed by clinical examination was the strongest factor associated with global and cardiovascular mortality in high risk type 2 diabetic patients.