{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T08:25:49Z","timestamp":1792571149161,"version":"4.5.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2019,4,16]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>The strength of association and optimal levels for risk factors related to excess risk of death and cardiovascular outcomes in type 1 diabetes mellitus have been sparsely studied.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>In a national observational cohort study from the Swedish National Diabetes Register from 1998 to 2014, we assessed relative prognostic importance of 17 risk factors for death and cardiovascular outcomes in individuals with type 1 diabetes mellitus. We used Cox regression and machine learning analyses. In addition, we examined optimal cut point levels for glycohemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol. Patients with type 1 diabetes mellitus were followed up until death or study end on December 31, 2013. The primary outcomes were death resulting from all causes, fatal\/nonfatal acute myocardial infarction, fatal\/nonfatal stroke, and hospitalization for heart failure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Of 32\u2009611 patients with type 1 diabetes mellitus, 1809 (5.5%) died during follow-up over 10.4 years. The strongest predictors for death and cardiovascular outcomes were glycohemoglobin, albuminuria, duration of diabetes mellitus, systolic blood pressure, and low-density lipoprotein cholesterol. Glycohemoglobin displayed \u22482% higher risk for each 1-mmol\/mol increase (equating to \u224822% per 1% glycohemoglobin difference), whereas low-density lipoprotein cholesterol was associated with 35% to 50% greater risk for each 1-mmol\/L increase. Microalbuminuria or macroalbuminuria was associated with 2 to 4 times greater risk for cardiovascular complications and death. Glycohemoglobin &lt;53 mmol\/mol (7.0%), systolic blood pressure &lt;140 mm\u2009Hg, and low-density lipoprotein cholesterol &lt;2.5 mmol\/L were associated with significantly lower risk for outcomes observed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Glycohemoglobin, albuminuria, duration of diabetes mellitus, systolic blood pressure, and low-density lipoprotein cholesterol appear to be the most important predictors for mortality and cardiovascular outcomes in patients with type 1 diabetes mellitus. Lower levels for glycohemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol than contemporary guideline target levels appear to be associated with significantly lower risk for outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.118.037454","type":"journal-article","created":{"date-parts":[[2019,2,25]],"date-time":"2019-02-25T10:01:24Z","timestamp":1551088884000},"page":"1900-1912","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":160,"title":["Relative Prognostic Importance and Optimal Levels of Risk Factors for Mortality and Cardiovascular Outcomes in Type 1 Diabetes Mellitus"],"prefix":"10.1161","volume":"139","author":[{"given":"Aidin","family":"Rawshani","sequence":"first","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden (A. Rawshani, A. Rawshani, B.E., A. Rosengren, S.G.)."},{"name":"Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden (A. Rawshani, A. Rawshani, S.F., B.E., A.-M.S., M.M., S.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Araz","family":"Rawshani","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden (A. Rawshani, A. Rawshani, B.E., A. Rosengren, S.G.)."},{"name":"Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden (A. Rawshani, A. Rawshani, S.F., B.E., A.-M.S., M.M., S.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveed","family":"Sattar","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (N.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Franz\u00e9n","sequence":"additional","affiliation":[{"name":"Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden (A. Rawshani, A. Rawshani, S.F., B.E., A.-M.S., M.M., S.G.)."},{"name":"Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Sweden (S.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren K.","family":"McGuire","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"Eliasson","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden (A. Rawshani, A. Rawshani, B.E., A. Rosengren, S.G.)."},{"name":"Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden (A. Rawshani, A. Rawshani, S.F., B.E., A.-M.S., M.M., S.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann-Marie","family":"Svensson","sequence":"additional","affiliation":[{"name":"Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden (A. Rawshani, A. Rawshani, S.F., B.E., A.-M.S., M.M., S.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"Zethelius","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences\/Geriatrics, Uppsala University, Sweden (B.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mervete","family":"Miftaraj","sequence":"additional","affiliation":[{"name":"Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden (A. Rawshani, A. Rawshani, S.F., B.E., A.-M.S., M.M., S.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Rosengren","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden (A. Rawshani, A. Rawshani, B.E., A. Rosengren, S.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soffia","family":"Gudbj\u00f6rnsdottir","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden (A. Rawshani, A. Rawshani, B.E., A. Rosengren, S.G.)."},{"name":"Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden (A. Rawshani, A. Rawshani, S.F., B.E., A.-M.S., M.M., S.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1608664"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.16425"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.025961"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1408214"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8227(14)70732\u20136"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-450"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/biostatistics\/kxr047"},{"key":"e_1_3_3_9_2","volume-title":"R-Package: Random Forest for Survival, Regression and Classification (RF-SRC)","author":"Ishwaran H","year":"2018","unstructured":"Ishwaran, H, Kogalur, UB. R-Package: Random Forest for Survival, Regression and Classification (RF-SRC). Vienna, Austria:R Foundation for Statistical Computing;2018. R-package version 1.6.1."},{"key":"e_1_3_3_10_2","unstructured":"Ridgeway G. gbm: Generalized boosted regression models: R-package version 2.1.1. 2015. http:\/\/CRAN.R-project.org\/package=gbm. Accessed March 28 2019."},{"key":"e_1_3_3_11_2","first-page":"18","article-title":"Classification and regression by randomForest: R-package.","volume":"2","author":"Liaw A","year":"2002","unstructured":"Liaw, A, WienerM. Classification and regression by randomForest: R-package. R News. 2002;2:18\u201322.","journal-title":"R News"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.ATV.19.4.1014"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc08-0107"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-010-1860-3"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.5.1374"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.2337\/db13-1093"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa052187"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.24.6.1053"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-2450"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61368-4"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2018.1470"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.3.521"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001321"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.2337\/db08-1543"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2008.2"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2011.03.006"},{"key":"e_1_3_3_27_2","first-page":"1","article-title":"Prevalence and management of hypertension in type 1 diabetes mellitus in Europe: the EURODIAB IDDM Complications Study.","author":"Collado-Mesa F","year":"1998","unstructured":"Collado-Mesa, F, Colhound, HM, Stevens, LK, Boavida, J, Ferriss, JB, Karamanos, B, Kempler, P, Michel, G, Roglic, G, Fuller, JH. Prevalence and management of hypertension in type 1 diabetes mellitus in Europe: the EURODIAB IDDM Complications Study. Diabetes Med. 1998:1\u20138. doi.org\/10.1046\/j.1464-5491.1999.00007.x","journal-title":"Diabetes Med"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.118.037454","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T07:48:10Z","timestamp":1715586490000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.118.037454"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,16]]},"references-count":26,"journal-issue":{"issue":"16","published-print":{"date-parts":[[2019,4,16]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.118.037454"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.118.037454","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,16]]},"assertion":[{"value":"2018-08-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-01-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}