PREDICTORS OF 10-YEAR MACROVASCULAR AND OVERALL MORTALITY IN PATIENTSWITH NIDDM - THE MUNICH GENERAL-PRACTITIONER PROJECT

The 10-year follow-up of the Munich General Practitioner Project was d esigned as a long-term prospective study to evaluate factors predictin g macrovascular and overall mortality in a random cohort of non-insuli n-dependent diabetic (NIDDM) patients. Of the original 290 patients (1 03 males, 187 females, median age 65 years) 92.5 % could be assessed, 103 subjects had died, 58 from macrovascular causes. In an univariate analysis of baseline data, deceased patients, and especially those who died from macrovascular causes had significantly higher fasting blood glucose, HbA(1c), von Willebrand-factor protein, urine albumin excret ion, and serum beta(2)-microglobulin, were significantly older, exhibi ted significantly more ischaemic heart disease (abnormal ECG Minnesota codes), carotid artery and peripheral vascular disease (both determin ed by ultrasound-Doppler) and had significantly inferior knowledge abo ut diabetes and its treatment. No significant differences were seen fo r gender, blood pressure, smoking, total. cholesterol, triglycerides, HDL-cholesterol, or the use of antidiabetic, antihypertensive or coron ary drugs. In a multiple logistic regression analysis, the risk factor s for macrovascular death were age, HbA(1c) and von Willebrand-factor protein. When baseline macrovascular disease was taken into account, c arotid artery disease was also a determinant. The main variables from the metabolic syndrome (blood pressure, dyslipidaemia, body mass index ) did not enter a multiple logistic regression analysis. The data sugg est that age and haemoglobin A(1c) are major determinants, and that in addition von Willebrand-factor associated endothelial damage is a ris k factor for macrovascular mortality in NIDDM patients.