New hemodialysis patients with no evidence of coronary calcification showed little evidence of disease development over 18 months independent of phosphate binder therapy. However, subjects with evidence of at least mild coronary calcification had significant progression at 6, 12, and 18 months. Use of calcium containing phosphate binders resulted in more rapid progression of coronary calcification than did use of sevelamer hydrochloride.

The objective of this is study was to examine whether estimated insulin resistance and insulin resistancerelated factors are associated with coronary artery calcification (CAC) in 1,420 asymptomatic participants in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study. A total of 656 patients with type 1 diabetes and 764 control subjects aged 20 -55 years were examined. CAC was assessed by electron-beam computed tomography. Insulin resistance was computed with linear regression based on an equation previously validated in clamp studies on type 1 diabetic adults. Insulin resistance was associated with CAC (OR 1.6 in type 1 diabetes and 1.4 in control subjects, P < 0.001), independent of coronary artery disease risk factors. There was a male excess of CAC in control subjects (OR 2.7, adjusted for age, smoking, and LDL and HDL cholesterol levels) and in type 1 diabetic patients (OR 2.2, adjusted for the same factors and diabetes duration). After adjusting for insulin resistance, the CAC male excess in diabetic patients decreased from OR 2.2 (P < 0.001) to 1.8 (P ‫؍‬ 0.04). After adjustment for waist-tohip ratio, waist circumference, or visceral fat, the gender difference in CAC was not significant in diabetic subjects. In conclusion, gender differences in insulin resistance-associated fat distribution may explain why type 1 diabetes increases coronary calcification in women relatively more than in men.

Background-Circulating adiponectin levels are lower in men than in women and lower in advanced coronary artery disease, obesity, and type 2 but not type 1 diabetes. However, it is not known whether low adiponectin levels predict development of atherosclerosis independently of other cardiovascular risk factors. Methods and Results-Progression of coronary artery calcification (CAC) over an average of 2.6 years (range, 1.6 to 3.3)was assessed in a cohort of patients with type 1 diabetes and nondiabetic subjects 19 to 59 years of age. In this nested case-control substudy, plasma adiponectin levels were measured in 101 cases with significant CAC progression and in 205 controls. Controls were oversampled on the basis of age, gender, diabetes status, and presence of baseline CAC. In conditional logistic regression adjusted for baseline CAC volume and other significant predictors of CAC progression, adiponectin levels were inversely related to progression of CAC in diabetic (OR, 0.47; 95% CI, 0.24 to 0.94) and nondiabetic (OR, 0.15; 95% CI, 0.05 to 0.40 for a doubling in adiponectin levels) subjects. Adjustment for additional cardiovascular risk factors did not change this association. In conditional logistic regression models by quartiles of plasma adiponectin levels, the probability value for trend was statistically significant for all participants (PϽ0.001) and nondiabetic participants (PϽ0.001) and was borderline for type 1 diabetics (Pϭ0.08). Conclusions-Low

Using the square root of the calcium volume score stabilized interscan variability across the range of coronary calcium. Defining change in coronary calcium as greater than or equal to 2.5 mm(3) of the difference in the square root-transformed calcium volume scores provided an estimate that was unbiased with respect to baseline coronary calcium. This analytic technique may facilitate investigations of the relevance of changes in coronary calcium to clinical outcomes and the use of changes in coronary calcium as a measure of the therapeutic impact on subclinical disease in clinical trials.

OBJECTIVE -To compare the prevalence, awareness, treatment, and control of hypertension in a population-representative sample of adults with type 1 diabetes and comparable nondiabetic control subjects. , the Coronary Artery Calcification in Type 1 Diabetes Study enrolled 1,416 individuals aged 19 -56 years with no known history of coronary artery disease: 652 type 1 diabetic patients (46% male, mean age 37 years) and 764 nondiabetic control subjects (50% male, mean age 39 years). Subjects were asked if they had been told by a physician that they had hypertension or were on a blood pressure medication. Blood pressure was measured using standardized Joint National Committee (JNC) protocol. RESEARCH DESIGN AND METHODSRESULTS -Type 1 diabetic subjects, compared with nondiabetic subjects, had higher rates of hypertension prevalence (43 vs. 15%, P Ͻ 0.001), awareness (53 vs. 45%, P ϭ 0.11), treatment (87 vs. 47%, P Ͻ 0.001), and control (55 vs. 32%, P Ͻ 0.001) for the JNC 6 goal (130/85 mmHg). Only 42% of all type 1 diabetic hypertensive subjects met the new JNC 7 goal (130/80 mmHg). Type 1 diabetic subjects had better blood pressure control (72 vs. 32%, P Ͻ 0.0001), using 140/90 mmHg as a common measure. The majority of treated subjects were on a single antihypertensive agent (75 vs. 64%).CONCLUSIONS -Subjects with type 1 diabetes have higher rates of hypertension prevalence, treatment, and control than nondiabetic subjects. However, hypertension remains largely uncontrolled, even if treated in high-risk populations, such as type 1 diabetic subjects and undiagnosed individuals in the general population. Achieving more stringent blood pressure goals will require increased attention and may necessitate the use of multiple antihypertensive agents. Diabetes Care 28:301-306, 2005N umerous advances in care have led to improved health and longer survival in patients with type 1 diabetes. Hypertension has been estimated to affect ϳ30% of type 1 diabetic patients and usually reflects the development of diabetic nephropathy (1). Effective control of blood pressure is a well-established target to decrease morbidity and mortality in patients with type 1 diabetes and nondiabetic individuals as well (1,2).In type 1 diabetes, hypertension is related to an increased risk of microvascular complications, such as retinopathy (3-5), and is a modifiable risk factor in the progression of nephropathy (6) as well as in the development of the macrovascular complications of cardiovascular disease (7,8). The risk of cardiovascular disease doubles with each increase of 20/10 mm/Hg beginning at 115/75 mm/Hg (2). It has been estimated that 35-75% of diabetes complications are due to hypertension (9). Recently revised guidelines have been published by both the American Diabetes Association (ADA) (1) and the Joint National Committee (JNC) 7 (2) regarding goals for blood pressure treatment.Reports on prevalence, awareness, treatment, and control of hypertension exist for the general population (10,11) and the type 2 diabetic population (12-16), wher...

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Combination therapy with PEG IFN alpha-2b plus RBV is more effective in patients who relapsed after combination standard IFN plus RBV than in nonresponders to either combination therapy or IFN monotherapy. There was no significant effect of dosing regimen.

OBJECTIVE—Coronary artery disease (CAD) occurs earlier in life and is more often fatal in people with type 1 diabetes. This excess risk seems to be higher than in those with type 2 diabetes and is poorly explained by conventional risk factors. The role of glycemic control is controversial and has not been previously addressed in a prospective manner using a reliable marker for subclinical CAD, such as coronary artery calcification (CAC), measured by electron beam computed tomography (EBCT). RESEARCH DESIGN AND METHODS—We measured CAC twice during an interval of 2.7 years in 109 men and women with type 1 diabetes (aged 22–50 years). Progression of CAC was found in 21 patients, based on change in the square root-transformed volume score. RESULTS—In multiple logistic regression, CAC progression was associated with baseline hyperglycemia (odds ratio [OR] 7.11, 95% CI 1.38–36.6, P = 0.02), adjusted for the presence of CAC at baseline (P = 0.01), duration of diabetes (P = 0.02), sex (P = 0.09), and age (P = 0.27). There was also a significant interactive effect of higher insulin dose and higher BMI (P = 0.03). CONCLUSIONS—In conclusion, in this young cohort with type 1 diabetes, suboptimal glycemic control (HbA1c &gt;7.5%) was a strong risk factor for progression of CAC. Insulin resistance may also play a role.