OBJECTIVE -Type 1 diabetes increases the risk for coronary artery disease (CAD), but limited information is available regarding the early natural history of this process. Electron beam tomography (EBT) can measure coronary artery calcification (CAC), an early marker for CAD. This study was designed to assess the prevalence and risk factors for CAC in young adults with established type 1 diabetes. RESEARCH DESIGN AND METHODS-A total of 101 subjects aged 17-28 years with type 1 diabetes of over 5 years' duration and no history of heart disease underwent cardiac EBT with calcium scoring. Medical histories were obtained and physical examinations were conducted to document the presence of cardiac risk factors as well as evidence of microvasculopathy and diabetic arthropathy. Laboratory evaluation included measurement of fasting lipoproteins, homocysteine concentration, lipoprotein(a) [Lp(a)], urinary microalbumin, and HbA 1c . Contingency table analysis was used to assess bivariate relationships. Logistic regression was employed to construct a parsimonious model of independent risk factors.RESULTS -Eleven subjects (10.9%) had CAC. Smokers were nearly five times more likely than nonsmokers to have CAC (P ϭ 0.03). In addition, each 0.36-mm/l increment of Lp(a) was associated with a 10% increased risk for CAC (P ϭ 0.05) after controlling for potentially confounding factors. There was no association of other CAD or diabetes risk factors studied with CAC.CONCLUSIONS -The prevalence of early CAD as evidenced by CAC in young adults with type 1 diabetes is significant. Smoking and Lp(a) levels independently predict the presence of CAC. Additional study is necessary to delineate the natural history of CAC and the role of risk factor modification to prevent progression of CAD in this high-risk population. Diabetes Care 26:433-436, 2003P atients with type 1 diabetes have an increased risk for developing early and severe coronary artery disease (CAD). Krolewski et al. (1) reported that by 55 years of age, the cumulative mortality rate from CAD in this population was 30 -40%. This finding compares with an overall mortality rate of 4 -8% in nondiabetic subjects as reported in the Framingham Study (2).Findings consistent with early coronary atherosclerosis have been documented in late adolescence and early adulthood. Both pathological and intravascular ultrasound studies have demonstrated atheromatous lesions and coronary wall abnormalities consistent with early CAD (3-6). These findings, however, have not been associated with clinically apparent disease. Indeed, the clinical diagnosis of CAD is usually made when symptoms of coronary insufficiency or myocardial infarction have occurred. Diagnosis at this late stage places individuals at an increased risk for chronic cardiac morbidity and mortality.Earlier identification of CAD may afford the opportunity for timely and aggressive risk factor modification that has the potential to alter the natural history of atherosclerosis and slow CAD progression.Intramural coronary calcification ...
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