High mortality and morbidity among adults with congenital heart disease and type 2 diabetes

Abstract

>Objectives. With improving prognosis the prevalence of adult congenital heart disease (ACHD) is increasing. Patients with type 2 diabetes mellitus (T2DM) have a shorter life expectancy compared with the general population. We investigated, in a large national diabetes registry, the prevalence of ACHD in combination with T2DM to estimate the associated clinical risk, outcome and patient characteristics. Design. Data from the Swedish National Diabetes Register (NDR) were linked with the Swedish National Patient Register (NPR) and the Cause of Death Register. Results. 833 ACHD patients were matched with 5 controls each. ACHD patients had significantly lower body mass index or BMI, higher creatinine and were more sedentary as compared with patients with T2DM but without congenital heart disease. The overall mortality was 26.2% for ACHD patients as compared with 19.9% (P < 0.001) for the control group, and five-year mortality rates were 5.2 versus 3.4%, P = 0.014. Conclusions. Congenital heart disease and secondary risk factors for cardiovascular disease frequently coexist and the development of T2DM also in the ACHD population is not uncommon with an estimated prevalence of between 4 and 8%. Treatment of conventional cardiovascular risk factors in patients with congenital heart disease could be considered secondary prevention given the relatively high morbidity and high risk for mortality observed in patients with the combination of ACHD and T2DM.