| dc.contributor.author | Hero, Christel | |
| dc.date.accessioned | 2020-01-08T10:18:55Z | |
| dc.date.available | 2020-01-08T10:18:55Z | |
| dc.date.issued | 2020-01-08 | |
| dc.identifier.isbn | 978-91-7833-715-6 (PDF) | |
| dc.identifier.isbn | 978-91-7833-714-9 (PRINT) | |
| dc.identifier.uri | http://hdl.handle.net/2077/62216 | |
| dc.description.abstract | Background: Cardiovascular disease (CVD) is a major cause of shortened
longevity in individuals with type 1 diabetes. Dyslipidemia is one of the
important modifiable risk factors.
Aims: To investigate different aspects of dyslipidemia in type 1 diabetes.
Assessing available blood lipid variables as markers of CVD risk in type 1
diabetes and the associations between lipid-lowering therapy (LLT) and
CVD in primary prevention. Investigating the adherence to LLT, the
association between non-adherence and CVD risk, and the factors associated
with non-adherence from a demographic and socioeconomic perspective.
Methods: The studies comprise individuals with type 1 diabetes registered
in the Swedish National Diabetes Register (NDR). Clinical characteristics
and laboratory measures were collected from the NDR together with data
from other nationwide Swedish registries on health and socioeconomy. In
study I, Cox regression analyses were performed to assess low-density
lipoprotein (LDL)-cholesterol and total cholesterol to high-density
lipoprotein (HDL)-cholesterol ratio as predictors of CVD in individuals with
type 1 diabetes. In study II, the association between primary prevention with
LLT and the risk of CVD was analyzed in 24,330 individuals with type 1
diabetes applying propensity scores to balance the groups. In studies III and
IV, we utilized the Swedish Prescribed Drug Register to investigate
adherence and non-adherence in 6192 individuals with type 1 diabetes and
novel users of LLT in the context of CVD and socioeconomy.
Results: Total cholesterol to HDL-cholesterol ratio was a better predictor
for cardiovascular risk in primary prevention than LDL-cholesterol, with a
12% elevated risk of CVD per 1 unit increase in the ratio. Individuals with
type 1 diabetes and no history of CVD had a 22-44% lower risk of CVD and
cardiovascular death when on LLT compared to the untreated individuals.
High adherence to LLT was associated with a 22% lower risk of non-fatal
CVD compared to a lower degree of adherence. Individuals discontinuing
LLT within 18 months had a 43% higher risk of non-fatal CVD. Lower
adherence was associated with male gender, younger age, marital status, and
country of birth.
Conclusion: These observational studies emphasize the importance of
regularly assessing and treating dyslipidemia in individuals with type 1
diabetes in order to achieve full cardioprotective treatment and lessen the
cardiovascular burden in the type 1 diabetes population. | sv |
| dc.language.iso | eng | sv |
| dc.relation.haspart | I. Hero C, Svensson A-M, Gidlund P, Gudbjörnsdottir
S, Eliasson B, Eeg-Olofsson K. LDL-cholesterol is
not a good marker of cardiovascular disease in Type
1 diabetes. Diabet Med. 2016, 33(3):316-323 ::doi::10.1111/dme.13007 | sv |
| dc.relation.haspart | II. Hero C, Rawshani A, Svensson A-M, Franzén S,
Eliasson B, Eeg-Olofsson K, Gudbjörnsdottir S.
Association between use of lipid-lowering therapy
and cardiovascular diseases and death in individuals
with type 1 diabetes. Diabetes Care. 2016;39(6):996-
1003 ::doi::10.2337/dc15-2450 | sv |
| dc.relation.haspart | III. Hero C, Karlsson S, Franzén S, Svensson A-M,
Miftaraj M, Gudbjörnsdottir S, Andersson Sundell
K, Eliasson B, Eeg-Olofsson K. Adherence to lipidlowering therapy and risk for cardiovascular disease
and death in type 1 diabetes mellitus. Accepted for
publication BMJ Open Diabetes Research and Care | sv |
| dc.relation.haspart | IV. Hero C, Karlsson S, Franzén S, Svensson A-M,
Miftaraj M, Gudbjörnsdottir S, Andersson Sundell
K, Eliasson B, Eeg-Olofsson K. Impact of
socioeconomic factors and gender on refill
adherence and persistence to lipid-lowering therapy
in type 1 diabetes. Manuscript | sv |
| dc.subject | Type 1 diabetes | sv |
| dc.subject | dyslipidemia | sv |
| dc.title | Epidemiological Aspects on Assessing and Treating Dyslipidemia in Type 1 Diabetes | sv |
| dc.title.alternative | Studies from the Swedish National Diabetes Register | sv |
| dc.type | text | eng |
| dc.type.svep | Doctoral thesis | eng |
| dc.gup.mail | Christel.hero@vgregion.se | sv |
| dc.type.degree | Doctor of Philosophy (Medicine) | sv |
| dc.gup.origin | University of Gothenburg. Sahlgrenska Academy | sv |
| dc.gup.department | Institute of Medicine. Department of Molecular and Clinical Medicine | sv |
| dc.gup.defenceplace | Fredagen den 31 januari 2020, kl 9.00, Hjärtats Aula, Vita stråket 12,Sahlgrenska Universitetssjukhuset, Göteborg | sv |
| dc.gup.defencedate | 2020-01-31 | |
| dc.gup.dissdb-fakultet | SA | |
