Risk Factors for Coronary Heart Disease in Type 1 Diabetic Patients in Europe

Abstract

OBJECTIVE -The goal of the study was to examine risk factors in the prediction of coronary heart disease (CHD) and differences in men and women in the EURODIAB Prospective Complications Study. RESEARCH DESIGN AND METHODS -Baseline risk factors and CHD at follow-upwere assessed in 2,329 type 1 diabetic patients without prior CHD. CHD was defined as physician-diagnosed myocardial infarction, angina pectoris, coronary artery bypass graft surgery, and/or Minnesota-coded ischemic electrocardiograms or fatal CHD.RESULTS -There were 151 patients who developed CHD, and the 7-year incidence rate was 8.0 (per 1,000 person-years) in men and 10.2 in women. After adjustment for age and/or duration of diabetes, the following risk factors were related to CHD in men: age, GHb, waistto-hip ratio (WHR), HDL cholesterol, smoking, albumin excretion rate (AER), and autonomic neuropathy. The following risk factors were related to CHD in women: age, systolic blood pressure (BP), fasting triglycerides, AER, and retinopathy. Multivariate standardized Cox proportional hazards models showed that age (hazard ratio 1.5), AER (1.3 in men and 1.6 in women), WHR (1.3 in men), smoking (1.5 in men), fasting triglycerides (1.3 in women) or HDL cholesterol (0.74 in women), and systolic BP (1.3 in women) were predictors of CHD.CONCLUSIONS -This study supports the evidence for a strong predictive role of baseline albuminuria in the pathogenesis of CHD in type 1 diabetes. Furthermore, sex-specific risk factors such as systolic BP, fasting triglycerides (or HDL cholesterol), and WHR were found to be important in the development of CHD. Diabetes Care 27:530 -537, 2004T ype 1 diabetes is associated with a four-(in men) to eightfold (in women) excess risk of coronary heart disease (CHD) (1,2). This substantially elevated risk in women with diabetes effectively obliterates the sex difference in CHD observed in the general population (3,4).Established risk factors do not appear to account for the excess risk of CHD in type 1 diabetes, and reasons for the greater impact in women are not clear. But there is a lack of large prospective studies in type 1 diabetic patients. Much of the research into CHD risk in diabetes has focused on type 2 diabetes and insulin resistance. Type 1 diabetes has a different pathogenesis from type 2 diabetes, and although there are similarities between the diseases such as hyperglycemia, inferences cannot be made from one type to the other for all risk factors, such as lipids and obesity. For example, type 1 diabetes is associated with a favorable lipid pattern compared with the general population, which is clearly not true for type 2 diabetes (5).Previous studies of type 1 diabetic patients suggest that albuminuria (4,6 -9) and raised blood pressure (BP) (4,6 -9) are important risk factors for CHD, but these studies had insufficient power to stratify analyses by sex. The case for an independent relationship between obesity measures and CHD is unclear, the role of the other complications of diabetes uncertain, and findings for lip...

Elevated serum levels of adiponectin in children, adolescents and young adults with type 1 diabetes and the impact of age, gender, body mass index and metabolic control: a longitudinal study

“…In addition, gender differences in the prevalence of atherosclerosis in type 1 diabetes could possibly be explained by the observed findings during puberty. Contrary to the healthy population, incidence rates and mortality of coronary heart disease (CHD) in women with type 1 diabetes are equal or even higher than in men (36,37). In type 1 diabetes, coronary artery calcification is greatly increased and the gender difference in calcification is lost (38).…”

“…In type 1 diabetes, coronary artery calcification is greatly increased and the gender difference in calcification is lost (38). The cardioprotective gender effect in healthy women is not present any longer in type 1 diabetes (36,37). The reasons for the greater impact of CHD in women with type 1 diabetes are not clear and little of this gender effect can be explained by known risk factors.…”

Alcohol consumption and risk of microvascular complications in type 1 diabetes patients: the EURODIAB Prospective Complications Study

“…HbA 1c (normal range 2.9-4.8%) was measured by an enzyme immunoassay using a monoclonal antibody raised against HbA 1c (Dako, Ely, UK). Plasma levels of triacylglycerol, and total and HDL-cholesterol concentrations were determined by standard enzymatic methods (Boehringer Mannheim, Burgess Hill, UK) using a Cobas-bio centrifugal analyser (Roche, Welwyn Garden City, UK) [15]. For HDL, samples with triacylglycerol concentrations >3.0 mmol/l were diluted with 0.15 mol/l sodium chloride solution before chemical precipitation.…”

“…For HDL, samples with triacylglycerol concentrations >3.0 mmol/l were diluted with 0.15 mol/l sodium chloride solution before chemical precipitation. LDL-cholesterol was calculated from Friedewald's formula if triacylglycerol was below 4.5 mmol/l [15]. Fifteen patients did not have their LDL-cholesterol calculated.…”

Changes in glycaemic control and risk of coronary artery disease in type 1 diabetes mellitus: findings from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC)

“…The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) reported that, whereas the HbA 1 level was associated with mortality from any heart disease (not controlling for renal disease), there was no significant relationship with myocardial infarction or angina specifically [7]. A significant age-and durationadjusted relationship reported in men (but not women) in the EURODIAB study disappeared with further adjustment for other cardiovascular risk factors [8]. A 10 year followup of patients at the Hvidore hospital in Denmark also failed to show an independent effect of HbA 1c , though the authors suggested that this might have been due to the small number of events [9].…”