Atherosclerosis and Microvascular Complications: Results From the Canadian Study of Longevity in Type 1 Diabetes

Lovshin, Julie A.; Bjornstad, Petter; Lovblom, Leif E.; Bai, Johnny-Wei; Boulet, Geneviève; Farooqi, Mohammed A.; Santiago, Sam; Orszag, Andrej; Scarr, Daniel; Weisman, Alanna; Keenan, Hillary A.; Brent, Michael H.; Paul, Narinder; Bril, Vera; Perkins, Bruce A.; Cherney, David Z.I.

doi:10.2337/dc18-1236

Cited by 43 publications

(32 citation statements)

References 41 publications

(41 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…42 Considerable coronary artery calci cation in adults with chronic type 1 DM was associated with retinopathy. 43 Our study, however, showed that these macrovascular diseases were inversely related to the risk of DR. Several explanations are possible. First, positive correlations are more frequently reported than negative ones.…”

Section: Discussioncontrasting

confidence: 57%

Effect of Anticoagulant/Antiplatelet Therapy on the Development and Progression of Diabetic Retinopathy

Jeng

Hsieh

Lin³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background:We investigated whether antiplatelet/anticoagulant (APAC) therapy can protect patients with type 2 diabetes mellitus (T2DM) from the development or progression of diabetic retinopathy (DR).Methods:This is a prospective cohort study using Longitudinal Health Insurance Database in Taiwan. A total of 73964 type 2 diabetic patients ≥ 20 years old were included. The cumulative incidence of nonproliferative DR (NPDR) was estimated and plotted for APAC users and nonusers using Kaplan–Meier curves, and the difference was assessed using the log-rank test. Incidence of NPDR, proliferative diabetic retinopathy (PDR), and diabetic macular edema (DME) were calculated by dividing the number of NPDR, PDR, and DME events by the total person-years for each group. A Cox proportional hazards model was used to assess the effect as hazard ratios (HRs) and corresponding 95% confidence intervals (CIs), with APAC use considered as a time-dependent covariate. Factors significant in the univariate model were adjusted in a multivariable model, namely, age; sex; comorbidities of hypertension, dyslipidemia, diabetic nephropathy, diabetic neuropathy, heart disease, cardiovascular disease, and peripheral arteriolar disease; and medications such as statins and fibrates. Results:Compared with nonusers, APAC users also had a lower cumulative incidence of NPDR (P < 0.001), overall incidence of NPDR (10.7 per 1000 person-years), and risk of developing NPDR (adjusted HR = 0.78, 95% CI = 0.73–0.83). However, no significant differences were observed between APAC users and nonusers in the risks of PDR or DME.Conclusion:APAC medicationshave a protective effect against NPDR but not against PDR or DME.

show abstract

Section: Discussioncontrasting

confidence: 57%

Effect of Anticoagulant/Antiplatelet Therapy on the Development and Progression of Diabetic Retinopathy

Jeng

Hsieh

Lin³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Older age and male sex have also been demonstrated to be associated with in-hospital death of COVID-19 patients (3,12). Thus, to adjust age and sex, an age-(62 years) and sex-matched COVID-19 patient without diabetes was randomly selected for each patient with diabetes according to previously reported similar methods (13,14). Whenever more than one patient was available for each patient with diabetes, the match was randomly selected from those available.…”

Section: Methodsmentioning

confidence: 99%

Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study

et al. 2020

View full text Add to dashboard Cite

OBJECTIVEDiabetes is common in COVID-19 patients and associated with unfavorable outcomes. We aimed to describe the characteristics and outcomes and to analyze the risk factors for in-hospital mortality of COVID-19 patients with diabetes. RESEARCH DESIGN AND METHODSThis two-center retrospective study was performed at two tertiary hospitals in Wuhan, China. Confirmed COVID-19 patients with diabetes (N 5 153) who were discharged or died from 1 January 2020 to 8 March 2020 were identified. One sexand age-matched COVID-19 patient without diabetes was randomly selected for each patient with diabetes. Demographic, clinical, and laboratory data were abstracted. Cox proportional hazards regression analyses were performed to identify the risk factors associated with the mortality in these patients. RESULTSOf 1,561 COVID-19 patients, 153 (9.8%) had diabetes, with a median age of 64.0 (interquartile range 56.0-72.0) years. A higher proportion of intensive care unit admission (17.6% vs. 7.8%, P 5 0.01) and more fatal cases (20.3% vs. 10.5%, P 5 0.017) were identified in COVID-19 patients with diabetes than in the matched patients. Multivariable Cox regression analyses of these 306 patients showed that hypertension (hazard ratio [HR] 2.50, 95% CI 1.30-4.78), cardiovascular disease (HR 2.24, 95% CI 1.19-4.23), and chronic pulmonary disease (HR 2.51, 95% CI 1.07-5.90) were independently associated with in-hospital death. Diabetes (HR 1.58, 95% CI 0.84-2.99) was not statistically significantly associated with in-hospital death after adjustment. Among patients with diabetes, nonsurvivors were older (76.0 vs. 63.0 years), most were male (71.0% vs. 29.0%), and were more likely to have underlying hypertension (83.9% vs. 50.0%) and cardiovascular disease (45.2% vs. 14.8%) (all P values <0.05). Age ‡70 years (HR 2.39, 95% CI 1.03-5.56) and hypertension (HR 3.10, 95% CI 1.14-8.44) were independent risk factors for in-hospital death of patients with diabetes. CONCLUSIONSCOVID-19 patients with diabetes had worse outcomes compared with the sex-and age-matched patients without diabetes. Older age and comorbid hypertension independently contributed to in-hospital death of patients with diabetes.

show abstract

“…Finally, although CAC is a proxy for the burden of subclinical atherosclerosis, it may not fully reflect the underlying burden of soft plaque. Nevertheless, CAC has predicted future cardiovascular events and adverse outcomes in a number of populations ( 33 , 34 ), including people with type 1 diabetes ( 5 , 6 , 35 ).…”

Section: Discussionmentioning

confidence: 99%

“…Type 1 diabetes is associated with an increased risk of CVD; adults with type 1 diabetes have more coronary artery calcium (CAC) than adults without diabetes ( 3 ), which in turn predicts higher rates of incident CVD and diabetes complications ( 4 – 6 ). The increase in cardiovascular risk differs by sex: women with type 1 diabetes see a greater increase in CAC and their overall cardiovascular risk than do men with type 1 diabetes ( 7 – 9 ).…”

Section: Introductionmentioning

confidence: 99%

Type 1 Diabetes Accelerates Progression of Coronary Artery Calcium Over the Menopausal Transition: The CACTI Study

et al. 2019

View full text Add to dashboard Cite

Type 1 diabetes is associated with a higher risk of cardiovascular disease (CVD) in women. Although menopause increases risk of CVD, it is uncertain how menopause affects risk of CVD in women with type 1 diabetes. We examined whether risk of CVD changes differentially in women with and those without type 1 diabetes over the transition through menopause. RESEARCH DESIGN AND METHODS Premenopausal women with type 1 diabetes (n 5 311) and premenopausal women without diabetes (n 5 325) enrolled in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study and attended up to four study visits over 18 years. Coronary artery calcium (CAC) volume was measured from computed tomography scans obtained at each visit. Longitudinal repeated-measures modeling estimated the effect of diabetes on CAC volume over time and the effect of menopause on the diabetes-CAC relationship. RESULTS CAC volume was higher at baseline and increased more over time in women with type 1 diabetes than in women without diabetes. A significant diabetes-bymenopause interaction was found (P < 0.0001): postmenopausal women with type 1 diabetes had significantly higher CAC volumes than premenopausal women (5.14 6 0.30 vs. 2.91 6 0.18 mm 3), while there was no difference in women without diabetes (1.78 6 0.26 vs. 1.78 6 0.17 mm 3). This interaction remained significant after adjusting for CVD risk factors. CONCLUSIONS Type 1 diabetes was associated with higher CAC volume and accelerated progression of CAC over time. Menopause increased CAC progression more in women with diabetes than in women without diabetes independent of age and other CVD risk factors known to worsen with menopause. Cardiovascular disease (CVD) is the leading cause of mortality in the U.S., but the risk of developing CVD varies significantly between men and women. On average, women have a lower risk of developing CVD than men of similar ages. Women tend to be diagnosed with CVD up to 10 years later than men, and as they undergo menopause and cease producing ovarian estrogen, their risk of CVD increases independently of age and other cardiovascular risk factors (1,2).

show abstract

Atherosclerosis and Microvascular Complications: Results From the Canadian Study of Longevity in Type 1 Diabetes

Cited by 43 publications

References 41 publications

Effect of Anticoagulant/Antiplatelet Therapy on the Development and Progression of Diabetic Retinopathy

Effect of Anticoagulant/Antiplatelet Therapy on the Development and Progression of Diabetic Retinopathy

Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study

Type 1 Diabetes Accelerates Progression of Coronary Artery Calcium Over the Menopausal Transition: The CACTI Study

Contact Info

Product

Resources

About