Elucidating causal effects of type 2 diabetes on ischemic heart disease from observational data on middle-aged Swedish women: a triangular analytical approach

Abstract The association between type 2 diabetes (T2D) and ischemic heart disease (IHD) is well established but the potential causal association needs further studying. In an attempt to elucidate the causal effect of T2D on IHD, we used three different analytical approaches in two different datasets...

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Autores principales:	Kristina Sundquist, Sven-Erik Johansson, Ashfaque A. Memon, Susanna Calling, Henrik Ohlsson, Robert Szulkin, Eladio Jimenez, Jan Sundquist
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/144838d6473f41339aead8409f4d1d1d
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spelling	oai:doaj.org-article:144838d6473f41339aead8409f4d1d1d2021-12-02T16:04:26ZElucidating causal effects of type 2 diabetes on ischemic heart disease from observational data on middle-aged Swedish women: a triangular analytical approach10.1038/s41598-021-92071-92045-2322https://doaj.org/article/144838d6473f41339aead8409f4d1d1d2021-06-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-92071-9https://doaj.org/toc/2045-2322Abstract The association between type 2 diabetes (T2D) and ischemic heart disease (IHD) is well established but the potential causal association needs further studying. In an attempt to elucidate the causal effect of T2D on IHD, we used three different analytical approaches in two different datasets. A well-defined cohort of 6047 women aged 50–59 years were included at baseline (1995 to 2000) and followed until 2015 for IHD. The median follow-up was 16.3 years. We used a Marginal Structural Cox model (MSM Cox) to account for time-varying exposure (time at onset of T2D) and for ten confounders (using inverse probability weighting, IPW). We also compared the MSM-Cox models with traditional Cox regression modelling in the cohort. Finally, we analyzed information on individuals from Swedish population-based registers with national coverage in a comprehensive co-relative design and extrapolated the results to MZ twins. The Hazard Ratio (HR) for IHD in relation to T2D at baseline and T2D occurring during the follow-up in the MSM Cox model weighted by IPW (based on the ten included confounders) was 1.43 (95% confidence interval [CI] 1.07–1.92). The corresponding HR from the traditional Cox regression model was of similar effect size. The average extrapolated MZ twin estimate from our co-relative model was 1.61 (95% CI 1.48–1.86). Our findings, based on a triangular approach, support the existence of a causal association between T2D and IHD and that preventive long-term measures in order to avoid or postpone IHD should include monitoring and treatment of both the T2D itself as well as other cardiovascular risk factors.Kristina SundquistSven-Erik JohanssonAshfaque A. MemonSusanna CallingHenrik OhlssonRobert SzulkinEladio JimenezJan SundquistNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Kristina Sundquist Sven-Erik Johansson Ashfaque A. Memon Susanna Calling Henrik Ohlsson Robert Szulkin Eladio Jimenez Jan Sundquist Elucidating causal effects of type 2 diabetes on ischemic heart disease from observational data on middle-aged Swedish women: a triangular analytical approach
description	Abstract The association between type 2 diabetes (T2D) and ischemic heart disease (IHD) is well established but the potential causal association needs further studying. In an attempt to elucidate the causal effect of T2D on IHD, we used three different analytical approaches in two different datasets. A well-defined cohort of 6047 women aged 50–59 years were included at baseline (1995 to 2000) and followed until 2015 for IHD. The median follow-up was 16.3 years. We used a Marginal Structural Cox model (MSM Cox) to account for time-varying exposure (time at onset of T2D) and for ten confounders (using inverse probability weighting, IPW). We also compared the MSM-Cox models with traditional Cox regression modelling in the cohort. Finally, we analyzed information on individuals from Swedish population-based registers with national coverage in a comprehensive co-relative design and extrapolated the results to MZ twins. The Hazard Ratio (HR) for IHD in relation to T2D at baseline and T2D occurring during the follow-up in the MSM Cox model weighted by IPW (based on the ten included confounders) was 1.43 (95% confidence interval [CI] 1.07–1.92). The corresponding HR from the traditional Cox regression model was of similar effect size. The average extrapolated MZ twin estimate from our co-relative model was 1.61 (95% CI 1.48–1.86). Our findings, based on a triangular approach, support the existence of a causal association between T2D and IHD and that preventive long-term measures in order to avoid or postpone IHD should include monitoring and treatment of both the T2D itself as well as other cardiovascular risk factors.
format	article
author	Kristina Sundquist Sven-Erik Johansson Ashfaque A. Memon Susanna Calling Henrik Ohlsson Robert Szulkin Eladio Jimenez Jan Sundquist
author_facet	Kristina Sundquist Sven-Erik Johansson Ashfaque A. Memon Susanna Calling Henrik Ohlsson Robert Szulkin Eladio Jimenez Jan Sundquist
author_sort	Kristina Sundquist
title	Elucidating causal effects of type 2 diabetes on ischemic heart disease from observational data on middle-aged Swedish women: a triangular analytical approach
title_short	Elucidating causal effects of type 2 diabetes on ischemic heart disease from observational data on middle-aged Swedish women: a triangular analytical approach
title_full	Elucidating causal effects of type 2 diabetes on ischemic heart disease from observational data on middle-aged Swedish women: a triangular analytical approach
title_fullStr	Elucidating causal effects of type 2 diabetes on ischemic heart disease from observational data on middle-aged Swedish women: a triangular analytical approach
title_full_unstemmed	Elucidating causal effects of type 2 diabetes on ischemic heart disease from observational data on middle-aged Swedish women: a triangular analytical approach
title_sort	elucidating causal effects of type 2 diabetes on ischemic heart disease from observational data on middle-aged swedish women: a triangular analytical approach
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/144838d6473f41339aead8409f4d1d1d
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Elucidating causal effects of type 2 diabetes on ischemic heart disease from observational data on middle-aged Swedish women: a triangular analytical approach

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