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Associations of Microvascular Complications With the Risk of Cardiovascular Disease in Type 1 Diabetes.

Associations of Microvascular Complications With the Risk of Cardiovascular Disease in Type 1 Diabetes.

Authors :
Gubitosi-Klug R
Gao X
Pop-Busui R
de Boer IH
White N
Aiello LP
Miller R
Palmer J
Tamborlane W
Wallia A
Kosiborod M
Lachin JM
Bebu I
Source :
Diabetes care [Diabetes Care] 2021 Jul; Vol. 44 (7), pp. 1499-1505. Date of Electronic Publication: 2021 May 12.
Publication Year :
2021

Abstract

Objective: We examined whether the presence of microvascular complications was associated with increased subsequent risk of cardiovascular disease (CVD) among participants with type 1 diabetes in the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study followed for >35 years.<br />Research Design and Methods: Standardized longitudinal data collection included: 1 ) stereoscopic seven-field retinal fundus photography centrally graded for retinopathy stage and clinically significant macular edema; 2 ) urinary albumin excretion rate (AER) and estimated glomerular filtration rate (eGFR); 3 ) cardiovascular autonomic neuropathy (CAN) reflex testing; and 4 ) adjudicated CVD events, including death from CVD, nonfatal myocardial infarction, stroke, subclinical myocardial infarction on electrocardiogram, confirmed angina, or coronary artery revascularization. Cox proportional hazards models assessed the association of microvascular complications with subsequent risk of CVD.<br />Results: A total of 239 participants developed CVD, including 120 participants who suffered major adverse cardiovascular events (MACE) defined as nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. The presence of microvascular disease (diabetic retinopathy, kidney disease, or CAN) was associated with increased risk of subsequent CVD and MACE (hazard ratios 1.86 to 3.18 and 2.09 to 3.63, respectively), associations that remained significant after adjusting for age and HbA <subscript>1c</subscript> . After adjustment for traditional CVD risk factors, however, only sustained AER ≥30 mg/24 h occurring alone and/or with eGFR <60 mL/min/1.73 m <superscript>2</superscript> and the presence of both retinal and kidney disease remained associated with CVD.<br />Conclusions: Advanced microvascular disease, especially moderate to severe albuminuria or eGFR <60 mL/min/1.73 m <superscript>2</superscript> , conveyed an increased risk of subsequent cardiovascular disease in the DCCT/EDIC cohort.<br /> (© 2021 by the American Diabetes Association.)

Details

Language :
English
ISSN :
1935-5548
Volume :
44
Issue :
7
Database :
MEDLINE
Journal :
Diabetes care
Publication Type :
Academic Journal
Accession number :
33980605
Full Text :
https://doi.org/10.2337/dc20-3104