Original studies

Diabetologia

, Volume 39, Issue 12, pp 1540-1545

First online:

Predictors of 10-year macrovascular and overall mortality in patients with NIDDM: the Munich General Practitioner Project

  • E. StandlAffiliated withDepartment of Endocrinology, City Hospital Schwabing, and Institute of Diabetes Research, Munich, Germany
  • , B. BalletshoferAffiliated withDepartment of Endocrinology, City Hospital Schwabing, and Institute of Diabetes Research, Munich, Germany
  • , B. DahlAffiliated withDepartment of Endocrinology, City Hospital Schwabing, and Institute of Diabetes Research, Munich, Germany
  • , B. WeichenhainAffiliated withDepartment of Angiology, City Hospital Schwabing, Munich, Germany
  • , H. StieglerAffiliated withDepartment of Angiology, City Hospital Schwabing, Munich, Germany
  • , A. HörmannAffiliated withInstitute for Medical Informatics and System Research, Munich, Germany
  • , R. HolleAffiliated withInstitute for Medical Informatics and System Research, Munich, Germany

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Summary

The 10-year follow-up of the Munich General Practitioner Project was designed as a long-term prospective study to evaluate factors predicting macrovascular and overall mortality in a random cohort of non-insulin-dependent diabetic (NIDDM) patients. Of the original 290 patients (103 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, HbA1c, von Willebrand-factor protein, urine albumin excretion, and serum β 2-microglobulin, were significantly older, exhibited significantly more ischaemic heart disease (abnormal ECG Minnesota codes), carotid artery and peripheral vascular disease (both determined by ultrasound-Doppler), and had significantly inferior knowledge about diabetes and its treatment. No significant differences were seen for gender, blood pressure, smoking, total cholesterol, triglycerides, HDL-cholesterol, or the use of antidiabetic, antihypertensive or coronary drugs. In a multiple logistic regression analysis, the risk factors for macrovascular death were age, HbA1c and von Willebrand-factor protein. When baseline macrovascular disease was taken into account, carotid 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 suggest that age and haemoglobin A1c are major determinants, and that in addition von Willebrand-factor associated endothelial damage is a risk factor for macrovascular mortality in NIDDM patients. [Diabetologia (1996) 39: 1540–1545]

Keywords Non-insulin-dependent diabetes mellitus mortality macrovascular mortality von Willebrand-factor urine albumin excretion HbA1c blood pressure lipids.