Incidence and determinants of mortality and cardiovascular events in diabetes mellitus: a meta-analysis

Patients with diabetes mellitus are at increased risk of developing atheros clerotic disease. The extent of this additional risk and its determinants a re not well known, but this information is needed for sample-size estimatio ns in intervention studies. Therefore, a meta-analysis of epidemiologic stu dies on this subject was performed. Medline was searched from 1966 onwards, including the reference lists of all relevant publications, A total of 27 prospective follow-up studies in the English language that allowed calculat ion of the unadjusted incidence of one of the predefined outcome events wer e included. The influence of age, sex, type of diabetes, duration of diabet es, year of study, HbA(1c), cholesterol level, blood pressure and smoking o n these incidences was studied by means of univariate Poisson regression an alysis. Overall total mortality was 2.9% per year (95% CI 2.8-3.0; 27 studies), and for death from all vascular causes was 1.4% per year (95% CI 1.3-1.4; 16 s tudies). Only two studies were found that reported on the incidence of the composite outcome 'event death from all vascular causes, non-fatal myocardi al infarction, or non-fatal stroke'. In univariate analysis, age, year of s tudy, total cholesterol and systolic blood pressure were positively related to total mortality and death from all vascular causes. After adjustment fo r age, or limiting the analyses to studies in patients with type 2 diabetes only (n = 11), these relationships remained statistically significant. In conclusion, the overall yearly total mortality in diabetes mellitus is 2.9% and for death from all vascular causes is 1.4%. There are few data on the incidence of composite cardiovascular outcome events.