Reduced Long‐Term Risk of Aortic Aneurysm and Aortic Dissection Among Individuals With Type 2 Diabetes Mellitus: A Nationwide Observational Study

<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> No studies have examined long‐term risks for aortic aneurysm ( <jats:styled-content style="fixed-case">AA</jats:styled-content> ) and aortic dissection ( <jats:styled-content style="fixed-case">AD</jats:styled-content> ) or mortality after <jats:styled-content style="fixed-case">AA</jats:styled-content> or <jats:styled-content style="fixed-case">AD</jats:styled-content> hospitalization among patients with type 2 diabetes mellitus (T2 <jats:styled-content style="fixed-case">DM</jats:styled-content> ). </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> In this observational cohort study, we linked data for patients with T2 <jats:styled-content style="fixed-case">DM</jats:styled-content> in the Swedish National Diabetes Register, and 5 individually matched population‐based control subjects ( <jats:styled-content style="fixed-case">CSs</jats:styled-content> ) without diabetes mellitus (on the basis of sex, age, and county), to other national databases to capture hospitalizations and death. We examined the risk of hospitalization for <jats:styled-content style="fixed-case">AA</jats:styled-content> and <jats:styled-content style="fixed-case">AD</jats:styled-content> , as well as mortality risk after <jats:styled-content style="fixed-case">AA</jats:styled-content> and <jats:styled-content style="fixed-case">AD</jats:styled-content> using Kaplan‐Meier curves and Cox regression hazards models. Data on 448 319 patients with T2DM and 2 251 015 <jats:styled-content style="fixed-case">CSs</jats:styled-content> were obtained between 1998 and 2015. Mean follow‐up time was 7.0 years for the T2 <jats:styled-content style="fixed-case">DM</jats:styled-content> group and 7.2 years for the CS group. Patients with T2 <jats:styled-content style="fixed-case">DM</jats:styled-content> had a relative risk reduction of 28% (hazard ratio, 0.72; 95% confidence interval, 0.68–0.76; <jats:italic>P</jats:italic> <0.0001) for <jats:styled-content style="fixed-case">AA</jats:styled-content> and a 47% relative risk reduction (hazard ratio, 0.53; 95% confidence interval, 0.42–0.65; <jats:italic>P</jats:italic> <0.0001) for <jats:styled-content style="fixed-case">AD</jats:styled-content> compared with <jats:styled-content style="fixed-case">CSs</jats:styled-content> . Patients with T2DM had a relative risk reduction of 12% (hazard ratio, 0.88; 95% confidence interval, 0.82–0.94; <jats:italic>P</jats:italic> <0.0001) for mortality after hospitalization for <jats:styled-content style="fixed-case">AA</jats:styled-content> , and unaltered risk (hazard ratio, 1.07; 95% confidence interval, 0.85–1.34; <jats:italic>P</jats:italic> =0.5859) for mortality after <jats:styled-content style="fixed-case">AD</jats:styled-content> , up to 2 years compared with <jats:styled-content style="fixed-case">CSs</jats:styled-content> . </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> Patients with T2DM had significantly reduced risks of <jats:styled-content style="fixed-case">AA</jats:styled-content> and <jats:styled-content style="fixed-case">AD</jats:styled-content> as well as reduced risk of mortality after hospitalization for <jats:styled-content style="fixed-case">AA, compared to CS</jats:styled-content> . Data suggest that glycated cross‐links in aortic tissue may play a protective role in the progression of aortic diseases among patients with T2DM. </jats:p> </jats:sec>