Noncardiovascular deaths are more common than cardiovascular deaths in patients with cardiovascular disease or cardiovascular risk factors and impaired glucose tolerance: Insights from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial

Patients with impaired glucose tolerance have an elevated risk of cardiovascular (CV) death; however, the causes and risk factors associated with non-CV deaths are poorly understood. The NAVIGATOR trial enrolled 9,306 participants with impaired glucose tolerance and CV disease or at high CV risk, wi...

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Bibliographic Details
Published in:The American heart journal 2017-04, Vol.186, p.73-82
Main Authors: Sharma, Abhinav, de Souza Brito, Flávio, Sun, Jie-Lena, Thomas, Laine, Haffner, Steven, Holman, Rury R., Lopes, Renato D.
Format: Article
Language:English
Subjects:
Aged
Blood cells
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - complications
Cardiovascular Diseases - mortality
Cause of Death
Clinical trials
Death
Diabetes
Drug overdose
Family medical history
Fasting
Fatalities
Female
Follow-Up Studies
Glucose
Glucose Intolerance - complications
Glucose tolerance
Health risk assessment
Health risks
Humans
Infections
Laboratories
Male
Malignancy
Melanoma
Middle Aged
Mortality
Myocardial infarction
Patients
Population
Potassium
Risk analysis
Risk Factors
Skin cancer
Statistical analysis
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Summary:Patients with impaired glucose tolerance have an elevated risk of cardiovascular (CV) death; however, the causes and risk factors associated with non-CV deaths are poorly understood. The NAVIGATOR trial enrolled 9,306 participants with impaired glucose tolerance and CV disease or at high CV risk, with a median follow-up of 6.4years. Using this population, we identified (1) the proportion of deaths attributed to CV, non-CV, and unknown causes, and (2) the risk factors associated with non-CV death. During the NAVIGATOR trial follow-up, 622 patients died. Investigators reported 244 (39.2%) CV deaths, 313 (50.3%) non-CV deaths, and 65 (10.5%) deaths of unknown cause. Myocardial infarction was the leading cause of investigator-reported death (57/622 [9.2%]). Among non-CV deaths, the most commonly identified cause related to malignancy (177/313 [56.5%]). Using adjudicated causes of death, Cox proportional hazard models identified 3 independent prognostic markers that increased the risk of non-CV death: history of non–melanoma skin cancer (hazard ratio 2.67 [95% CI 1.65-4.33]; P5000/mm3; 1.10 [1.02-1.18]; P=.011), and serum potassium levels (per 1mmol/L above any value; 1.67 [1.302.15]; P
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2016.12.011