Apolipoprotein B as a long‐term predictor of mortality in type 1 diabetes mellitus: a 15‐year follow up

. Objectives.  To evaluate the association of apolipoprotein B (apo B) with mortality due to all causes, to cardiac disease and to ischaemic heart disease (IHD) in subjects with type 1 diabetes mellitus. Subjects.  165 subjects with type 1 diabetes included in the Swiss Cohort of the WHO Multinational Study of Vascular Disease in Diabetes were followed for 14.7 ± 0.45 years. Methods.  Causes of death were obtained from death certificates, hospital records and postmortem reports. Using a parametric proportional hazards model the association of apo B with mortality rates was assessed by time‐to‐event analysis, including the absolute cumulative mortality risk over time for various apo B levels at baseline. Results.  Apo B was positively associated with all‐cause mortality [hazard ratio (HR) 2.65 per g L −1 increase of apo B, 95% CI: 1.11–6.36, P  = 0.029], cardiac mortality (HR 11.64, 1.03–131.11, P  = 0.047) and IHD mortality (HR 9.36, 1.26–69.66, P  = 0.029). An apo B ≥0.96 g L −1 translated into a duplication of overall mortality hazard (HR 1.93, 1.00–3.72, P  = 0.050), and a sevenfold increase of mortality because of cardiac disease or IHD (HR 7.44, 1.44–38.42, P  = 0.017 and HR 7.38, 0.78–69.82, P  = 0.081). A baseline apo B of 1.5 g L −1 predicted an absolute cumulative risk to die over the next 10 years of 12.1% (5.2–31.7) for male and of 10.4% (4.7–26.1) for female subjects whereas risks were 6.3% (1.8–21.4) and 5.4% (0.8–15.8) for an apo B of 0.8 g L −1 . Conclusion.  Apo B is consistently associated with an increased mortality in type 1 diabetes.