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Title: Risk factors for cardiovascular disease (CVD) in adults with type 1 diabetes: Findings from prospective real-life T1D Exchange Registry

Author
item SHAH, VIRAL - Colorado Health Science Center
item BAILEY, RYAN - Jaeb Center For Health Research
item WU, MENGDI - Jaeb Center For Health Research
item FOSTER, NICOLE - Jaeb Center For Health Research
item POP-BUSUI, RODICA - University Of Michigan
item KATZ, MICHELLE - Joslin Diabetes Center
item CRANDALL, JILL - Albert Einstein College Of Medicine
item BACHA, FIDA - Children'S Nutrition Research Center (CNRC)
item NADEAU, KRISTEN - Colorado Health Science Center
item LIBMAN, INGRID - University Of Pittsburgh Medical Center
item HIERS, PAUL - University Of Florida
item MIZOKAMI-STOUT, KARA - University Of Michigan
item DIMEGLIO, LINDA - Indiana University School Of Medicine
item SHERR, JENNIFER - Yale School Of Medicine
item PRATLEY, RICHARD - Adventhealth Translational Research Institute For Metabolism And Diabetes
item AGARWAL, SHIVANI - University Of Pennsylvania
item SNELL-BERGEON, JANET - Colorado Health Science Center
item CENGIZ, EDA - Yale School Of Medicine
item POLSKY, SARIT - Baylor College Of Medicine
item MEHTA, SANJEEV - Joslin Diabetes Center

Submitted to: Journal of Clinical Endocrinology and Metabolism
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/17/2020
Publication Date: 1/19/2020
Citation: Shah, V.N., Bailey, R., Wu, M., Foster, N.C., Pop-Busui, R., Katz, M., Crandall, J., Bacha, F., Nadeau, K., Libman, I., Hiers, P., Mizokami-Stout, K., Dimeglio, L.A., Sherr, J., Pratley, R., Agarwal, S., Snell-Bergeon, J., Cengiz, E., Polsky, S., Mehta, S.N. 2020. Risk factors for cardiovascular disease (CVD) in adults with type 1 diabetes: Findings from prospective real-life T1D Exchange Registry. Journal of Clinical Endocrinology and Metabolism. 105(5):e2032-e2038. https://doi.org/10.1210/clinem/dgaa015.
DOI: https://doi.org/10.1210/clinem/dgaa015

Interpretive Summary: Individuals with type 1 diabetes are at higher risk for cardiovascular disease (CVD) than those without diabetes. It is important to understand the risk factors for this increased risk. We evaluated the risk factors for CVD in a large sample of 8,727 adults with type 1 diabetes. A third of them used lipid lowering medication and a third were on blood pressure lowering medications. They were followed for about 4.6 years in the study. About 4% developed CVD. Older age, excess weight, blood sugar control, presence of high blood pressure or elevated lipids and longer diabetes duration, in addition to early kidney disease were related to the risk for CVD. There were no differences in risk for CVD between males and females. The findings indicate that treatment intensification to keep blood sugar in the normal range, treat high blood pressure, lower blood lipids and treat early kidney disease are all important measures to control risk factors in order to prevent CVD in this high risk population.

Technical Abstract: We prospectively evaluated CVD risk factors in a large, contemporary cohort of adults with type 1 diabetes living in the United States. Observational study of CVD and CVD risk factors over a median of 5.3 years. The T1D Exchange clinic network. Adults (age >/-18 years) with type 1 diabetes and without known CVD diagnosed before or at enrollment. Associations between CVD risk factors and incident CVD were assessed by multivariable logistic regression. The study included 8,727 participants (53% female, 88% non-Hispanic white, median age 33 years [IQR=21, 48], type 1 diabetes duration 16 years [IQR=9, 26]). At enrollment, median HbA1c was 7.6% (66 mmol/mol) [IQR=6.9 (52), 8.6 (70)], 33% used a statin, and 37% used blood pressure medication. Over a mean follow-up of 4.6 years, 325 (3.7%) participants developed incident CVD. Ischemic heart disease was the most common CVD event. Increasing age, BMI, HbA1c, presence of hypertension and dyslipidemia, increasing duration of diabetes, and diabetic nephropathy were associated with increased risk for CVD. There were no significant gender differences in CVD risk. HbA1c, hypertension, dyslipidemia and diabetic nephropathy are important risk factors for CVD in adults with type 1 diabetes. A longer follow-up is likely required to assess the impact of other traditional CVD risk factors on incident CVD in the current era.