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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...

This study in European patients with type 1 diabetes showed that a lower dietary GI is related to lower Hb A(1c) concentrations, independently of fiber intake. The consumption of bread and pasta had the biggest effect on the overall dietary GI of European outpatients.