Use this URL to cite or link to this record in EThOS:
Title: Microvascular disease as a cardiovascular risk factor in diabetes mellitus
Author: Brownrigg, Jack
ISNI:       0000 0004 6057 6546
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2016
Availability of Full Text:
Full text unavailable from EThOS.
Please contact the current institution’s library for further details.
Despite systematic approaches to cardiovascular disease (CVD) risk modification in diabetes, affected individuals remain at approximately 2-fold increased risk compared with non-diabetic individuals. Previous estimates suggest diabetes is associated with around 6-7 years of life lost; the majority of deaths can be attributed to vascular conditions. CVD risk estimation in diabetes is challenging, and existing models have performed moderately at best in external validation. This thesis presents a meta-analysis of mortality rates among 17,830 individuals with diabetes, comparing those with and without a history of foot ulceration. Findings of excess all-cause mortality observed with diabetic foot ulceration are expanded upon using institutional data with information on cause-specific mortality. A positive association between diabetic foot ulceration and CVD mortality is described using competing risks modelling. The relation between peripheral neuropathy, a key risk factor for ulceration, and CVD is described. Regression analyses on a primary care cohort of diabetic individuals, including 32,608 person years of follow-up, demonstrate that peripheral neuropathy is independently associated with increased risk for a first CVD event. Inclusion of information on peripheral neuropathy to a model based on established risk factors results in improved classification, calibration and discrimination for CVD risk. Finally, adjusted regression analyses of a linked primary and secondary care dataset, with over 250 000 person years of follow-up, quantify the association between microvascular disease burden and incident CVD. Estimates presented suggest that information on microvascular disease (peripheral neuropathy, nephropathy and/ or retinopathy) can identify individuals at high-risk who are currently perceived to be at lower absolute risk using contemporary risk equations Based on the event rates reported, individuals with prevalent microvascular disease would be eligible for aggressive risk modification treatment. Microvascular disease appears to represent at least a risk equivalent to established risk factors with implications for CVD risk stratification and modification.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available