Long-term predictors of coronary artery disease and mortality in type 1 diabetes

Abstract

We assessed clinical and biochemical predictors of death and/or cardiovascular disease in 147 type 1 diabetes mellitus (DM) patients followed-up for 14 years. At follow-up, 28 of patients (19%) had died, and 25 patients (18%) had developed or died of coronary artery disease (CAD). At baseline, those who died had significantly higher serum creatinine (p=0.001) and urine albumin/creatinine ratio (p=0.016), greater prevalence of retinopathy (p=0.006), lower serum apolipoprotein A1 (p=0.046), and lower daily insulin dose (p=0.024) than those who survived. CAD patients had a longer duration of diabetes (p<0.001), were older at the onset of diabetes and at presentation (p=0.001), and had higher prevalences of retinopathy (p=0.005) and neuropathy (p=0.016). The CAD group also had higher baseline serum creatinine (p=0.02), lower HDL cholesterol (p=0.004) and apolipoprotein A1 (p=0.007) and higher LDL cholesterol (p=0.028) and apolipoprotein B concentrations (p=0.027). Under logistic regression analysis (adjusted for age and sex), baseline urine albumin/creatinine ratio (p=0.003), presence of retinopathy (p=0.004), serum creatinine (p=0.028), and serum urea (p=0.034) were the most powerful predictors of mortality, while duration of diabetes (p<0.0001), baseline HDL cholesterol (p=0.012), serum creatinine (p=0.02), apolipoprotein B (p=0.038), LDL cholesterol (p=0.039), and systolic blood pressure (p=0.055) were the strongest predictors of CAD. These findings emphasize the role of abnormal lipoprotein metabolism in the development of CAD in type 1 DM. Indicators of renal impairment and the presence of retinopathy seem to be of greater importance in predicting overall mortality.

Type 1 Diabetes Mellitus and Cardiovascular Disease

“…The published cumulative incidence of CHD ranges between 2.1% 18 and 19%, 19 with most studies reporting cumulative incidences of ≈15% over ≈15 years of follow-up. [20][21][22] Cumulative CHD mortality rates over 14 to 18 years are reported as being between 6% and 8%, 19,22 are higher in men than in women, 23 and are higher in those >40 years of age than in those <40 years of age 23 (online-only Data Supplement Table I). Of interest, myocarditis after myocardial infarction has been described recently in a mouse model, with some evidence that a similar complication occurs in T1DM patients.…”

Competing-Risk Analysis of ESRD and Death among Patients with Type 1 Diabetes and Macroalbuminuria

“…It is therefore possible to speculate that poor glycemic control increases all-cause mortality in type 1 diabetes predominantly by promoting progression to ESRD. Furthermore, any studies that censored ESRD patients or had few progressors may therefore have observed no mortality risk associated with HbA 1c 10,11 . For example, the lack of association between HbA 1c and mortality in the Diabetes Control and Complications Trial (DCCT) trial may be partly because of the low incidence of ESRD.…”

Electrosynthesized molecularly imprinted polyscopoletin nanofilms for human serum albumin detection

“…elevated urinary excretion of albumin as in microalbuminuria [24] is an early indicator of kidney damage. Studies suggest that microalbuminuria defines a group at high risk of increased cardiovascular morbidity and mortality among patients with diabetes [25][26][27] or essential hypertension. [28] Moreover, microalbuminuria is associated with increased cardiovascular morbidity even in the non-diabetic, non-hypertensive population, [29] pointing out the necessity for routine screening of urinary albumin to enable prediction and prevention of future renal and cardiovascular diseases.…”