@misc{10481/70221,
year = {2021},
month = {6},
url = {http://hdl.handle.net/10481/70221},
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.},
organization = {Lund University},
organization = {ALF medel from Region Skane},
organization = {Swedish Heart-Lung Foundation},
publisher = {Nature},
title = {Elucidating causal effects of type 2 diabetes on ischemic heart disease from observational data on middle‑aged Swedish women: a triangular analytical approach},
doi = {10.1038/s41598-021-92071-9},
author = {Sundquist, Kristina and Jiménez Mejías, Eladio},
}