Risk Factor Modeling for Cardiovascular Disease in Type 1 Diabetes in the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study: A Comparison With the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC)

Abstract

In a recent Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study report, mean HbA1c was the strongest predictor of cardiovascular disease (CVD) after age. In DCCT/EDIC, mean diabetes duration was 6 years (median 4) at baseline and those with high blood pressure or cholesterol were excluded. We now replicate these analyses in the Pittsburgh Epidemiology of Diabetes Complications (EDC) prospective cohort study of childhood-onset (at <17 years of age) type 1 diabetes, with similar age (mean 27 years in both studies) but longer diabetes duration (mean 19 years and median 18 years) and no CVD risk factor exclusion at baseline. CVD incidence (CVD death, myocardial infarction (MI), stroke, revascularization, angina, or ischemic electrocardiogram) was associated with diabetes duration, most recent albumin excretion rate (AER), updated mean triglycerides, baseline hypertension, baseline LDL cholesterol, and most recent HbA1c. Major atherosclerotic cardiovascular events (CVD death, MI, or stroke) were associated with diabetes duration, most recent AER, baseline systolic blood pressure, baseline smoking, and updated mean HbA1c. Compared with findings in DCCT/EDIC, traditional risk factors similarly predicted CVD; however AER predominates in EDC and HbA1c in DCCT/EDIC. Thus, the relative impact of HbA1c and kidney disease in type 1 diabetes varies according to diabetes duration.

Insulin resistance is associated with preclinical carotid atherosclerosis in patients with type 1 diabetes

“…10 From this perspective, insulin resistance (IR) markers have emerged as an additional and significant CVD risk factor in the assessment of chronic vascular complications and mortality in the T1D population. 11,12 The gold standard test to measure insulin sensitivity is the euglycaemic hyperinsulinaemic clamp, which is inappropriate for using at a population level given that it is invasive and time consuming. 13 In 2000, a validated score against the euglycaemic hyperinsulinaemic clamp was developed to estimate the glucose disposal rate (eGDR) as a marker of the degree of insulin sensitivity in individuals with T1D.…”

“…14 Since it was released, the score has been used in several investigations for the assessment of clinical diabetic chronic complications in the T1D population. 11,12,[15][16][17] Nevertheless, the independent impact of eGDR or other IR markers on cardiovascular events or preclinical atherosclerosis has barely been studied.…”

Pathways leading to prevention of fatal and non-fatal cardiovascular disease: An interaction model on 15 years population-based cohort study

“…Although the indirect effects of family history of CVD, age, lipid profiles, anthropometric indices, healthy lifestyle, quality of life, high-risk behaviours, having hypertension and high blood sugar on CVDs were not covered in the literature, many studies discussed the direct effect of such factors in which these results are in line with [9,11,12,15,[38][39][40][41][42][43][44][45][46][47][48][49][50]. Causal networks evaluate causal relationships among variables beyond partial correlations and thus play a fundamental step in risk prediction.…”

Mesa 1: Diabetes mellitus tipo 1 y enfermedad cardiovascular

“…En el Epidemiology of Diabetes Complications (EDC), de Pittsburgh, la incidencia de eventos de enfermedad coronaria (EC) en adultos (28 a 38 años) con DM1 fue 0,98% por año y mayor al 3% anual después de los 55 años, lo que la convierte en la principal causa de muerte en esa población. La tasa de prevalencia de ECV varía según la edad, años de evolución desde el diagnóstico, edad al inicio de la enfermedad, sexo y posiblemente según la etnia 1,2,3,4,5,6,7 .…”

“…Además determinó que la glucemia predice fuertemente el edema agudo de pulmón (EAP) y la amputación, el accidente cerebrovascular (ACV). La EC tuvo una asociación más baja y el inicio puberal se asoció con mayor riesgo de muerte 4 .…”