Risk stratification for 25-year cardiovascular disease incidence in type 1 diabetes: Tree-structured survival analysis of the Pittsburgh Epidemiology of Diabetes Complications study

Miller, Rachel G.; Anderson, Stewart J.; Costacou, Tina; Orchard, Trevor J.

doi:10.1177/1479164116629353

Cited by 12 publications

(23 citation statements)

References 42 publications

(59 reference statements)

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“…Indeed, in an important recent report from DCCT/EDIC, the authors show that the association of HbA 1c with 10-year CVD risk seems to be increasingly mediated by other risk factors with increasing age and diabetes duration (23). Other EDC analyses have also provided evidence that renal disease is a particularly important predictor of CVD at longer type 1 diabetes durations (24). Current AER was a stronger predictor of CVD risk compared with baseline or mean AER in the current analyses, supporting the hypothesis that worsening AER with increasing type 1 diabetes duration is driving the association between AER and CVD incidence.…”

Section: Discussionmentioning

confidence: 99%

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)

2018

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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.

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Section: Discussionmentioning

confidence: 99%

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)

2018

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“…According to a review coauthored by the American Heart Association and the American Diabetes Association, cardiovascular events occur more frequently and earlier in patients with T1D than in nondiabetic populations . Although the precise mechanisms by which diabetes increases the likelihood of developing CVD are not completely defined, various pathological conditions may be responsible, including hypertension, hyperglycemia, and dyslipidemia. ,− Notably, it has been reported that microalbuminuria predicts vascular disease and that proteinuria may be a key marker for CVD and even death . Ostensibly, as nephropathy progresses, secondary metabolic disturbances may accelerate atherosclerosis and the onset of CVD .…”

Section: Discussionmentioning

confidence: 99%

Whole Egg Consumption Exerts a Nephroprotective Effect in an Acute Rodent Model of Type 1 Diabetes

Saande

Jones

Rowling

et al. 2018

J. Agric. Food Chem.

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Nephropathy is a well-characterized complication of type 1 diabetes (T1D), resulting in proteinuria and urinary loss of micronutrients. We previously found that a whole egg-based diet maintained vitamin D balance in type 2 diabetic rats despite excessive urinary losses due to nephropathy. The goal of this study was to investigate the impact of whole egg consumption in T1D rats. Sprague-Dawley rats were randomly assigned to T1D or nondiabetic control groups and fed a casein or whole egg-based diet for 32 days. On day 26, two-thirds of the rats received a streptozotocin injection to induce T1D. Whole egg consumption attenuated polyuria, proteinuria, and renal hypertrophy in T1D rats. These data suggest that dietary intervention with whole egg may offer renal protection in T1D.

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“…According to the latest European Society of Cardiology (ESC) guidelines on diabetes, prediabetes and CVD, patients with a longer T1D duration (i.e., > 10 years) are automatically considered at highor very high risk to develop CVD [6]. However, there seems to be substantial heterogeneity in CV risk in T1D [7,8]. Therefore, it is crucial to accurately assess CV risk in patients with T1D and there is growing research interest into CV risk stratification tools [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…However, there seems to be substantial heterogeneity in CV risk in T1D [7,8]. Therefore, it is crucial to accurately assess CV risk in patients with T1D and there is growing research interest into CV risk stratification tools [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Arterial stiffness in patients with type 1 diabetes and its comparison to cardiovascular risk evaluation tools

Helleputte

Bortel

Verbeke

et al. 2022

Cardiovasc Diabetol

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Background Arterial stiffness is a potential biomarker for cardiovascular disease (CVD) risk in patients with type 1 diabetes (T1D). However, its relation with other CV risk evaluation tools in T1D has not been elucidated yet. This study aimed to evaluate arterial stiffness in T1D patients free from known CVD, and compare it to other CV risk evaluation tools used in T1D. Methods Cross-sectional study in adults with a T1D duration of at least 10 years and without established CVD. Patients were categorized in CVD risk groups based on 2019 European Society of Cardiology (ESC) guidelines, and the STENO T1D risk engine was used to estimate 10-year risk for CV events. Arterial stiffness was evaluated with carotid-femoral pulse wave velocity (cf-PWV). Coronary artery calcium (CAC) score was assessed and carotid ultrasound was performed. Ambulatory 24-h blood pressure and central hemodynamic parameters were evaluated. Data on renal function and diabetic kidney disease was retrieved. Results 54 patients (age: 46 ± 9.5 years; T1D duration: 27 ± 8.8 years) were included. One-fourth of patients showed prematurely increased aortic stiffness based on cf-PWV (24%). Cf-PWV was significantly associated with CAC score, carotid intima-media thickness, central hemodynamic parameters and diabetic kidney disease. Based on STENO, 20 patients (37%) were at low, 20 patients (37%) at moderate, and 14 patients (26%) at high 10-year risk for CV event. Cf-PWV was strongly associated with the STENO score (rs = + 0.81; R2 = 0.566, p < 0.001), increasing with each higher STENO group (p < 0.01). However, cf-PWV was not significantly different between the two CV risk groups (high versus very high) based on ESC criteria, and ESC criteria compared to STENO classified 10 patients more as having > 10% 10-year risk for CV events (n = 44/54; 81.5% versus n = 34/54; 63%). Conclusions This study demonstrated that a substantial proportion of long-standing T1D patients free from known CVD show premature arterial stiffening. Cf-PWV strongly associates with the STENO risk score for future CV events and with cardiovascular imaging and function outcomes, thereby illustrating the clinical importance of arterial stiffness. The data, however, also show considerable heterogeneity in CV risk and differences in risk categorisation between the STENO tool and ESC criteria.There is a need for refinement of CV risk classification in T1D, and future studies should investigate if evaluation of arterial stiffness should be implemented in T1D clinical practice and which patients benefit the most from its assessment.

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Risk stratification for 25-year cardiovascular disease incidence in type 1 diabetes: Tree-structured survival analysis of the Pittsburgh Epidemiology of Diabetes Complications study

Cited by 12 publications

References 42 publications

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)

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)

Whole Egg Consumption Exerts a Nephroprotective Effect in an Acute Rodent Model of Type 1 Diabetes

Arterial stiffness in patients with type 1 diabetes and its comparison to cardiovascular risk evaluation tools

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