Risk factors differ by first manifestation of cardiovascular disease in type 1 diabetes. (May 2020)

• Record Type: Journal Article
• Authors: Miller, Rachel G.; Orchard, Trevor J.; Costacou, Tina
• Is Part Of: Diabetes research and clinical practice. Volume 163(2020)
• Publication Date: 2020-05
• Subjects: Cardiovascular disease manifestations -- Composite CVD Outcomes -- Revascularization -- CVD Risk Factors; CVD cardiovascular disease -- MACE major atherosclerotic coronary event -- CAD Coronary artery disease -- EDC Epidemiology of Diabetes Complications Study -- MI myocardial infarction -- AER albumin excretion rate -- eGFR estimated glomerular filtration rate -- WBC white blood cells; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2020.108141
• Languages: English
• ISSNs: 0168-8227

Abstract

Abstract: Aims: We compared risk factors for three CVD manifestations and a composite outcome over 25 years' follow-up in the Pittsburgh Epidemiology of Diabetes Complications (EDC) prospective cohort study of childhood-onset (<17 years) type 1 diabetes (n = 658). Methods: First CVD manifestations examined were: (1) major atherosclerotic cardiovascular event (MACE, i.e. CVD death, myocardial infarction, stroke), (2) coronary revascularization, (3) soft coronary artery disease (CAD, i.e. ischemia ECG, angina), and a (4) composite (MACE + revascularization) outcome. Baseline and time-varying mean and current risk factors, including medication use, were assessed, in diabetes duration-adjusted models. Results: MACE (n = 107) was predicted by ln(albumin excretion rate) (AER, HR = 1.3, p < 0.0001), systolic BP (SBP, HR = 1.03, p < 0.0001), white blood cell count (WBC, HR = 1.2, p < 0.0001), HbA1c (HR = 1.2p = 0.03), LDLc (HR = 1.01, p = 0.03). Soft CAD (n = 91) was predicted by ln(AER) (HR = 1.2, p = 0.004), SBP (HR = 1.03, p = 0.0002), WBC (HR = 1.2, p = 0.0003), HbA1c (HR = 1.2, p = 0.005). Revascularization (n = 38) was predicted by LDLc (HR = 1.03, p < 0.0001), eGFR (HR = 0.98, p = 0.002), HbA1c (HR = 1.3, p = 0.03). Adding revascularization to MACE enhanced the role of LDLc, while diminishing that of HbA1c, compared to MACE alone. Conclusions: Important risk factor associations may be affected by examining composite CVD outcomes. More research is needed to determine how to best incorporate revascularization into composite CVD definitions.