Report of the National Heart, Lung, and Blood Institute-National Institute of Diabetes and Digestive and Kidney Diseases Working Group on Cardiovascular Complications of Type 1 Diabetes Mellitus.

Cardiovascular disease (CVD) constitutes the major cause of mortality and morbidity in both type 1 (T1D) and type 2 (T2D) diabetes patients. Although the microvascular complications of T1D are well studied, macrovascular CVD, its treatment, and link to diabetes have been investigated primarily in T2D patients. On April 27 and 28, 2003, the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored a meeting to identify ways to close gaps in our knowledge about CVD in T1D to improve prevention and treatment. Participants were asked to: (1) Evaluate opportunities for studying the pathogenesis of CVD in T1D patients. Risk factors unique to these patients were of particular interest, as well as studies of the cause of CVD in T1D with respect to existing databases or cohorts and involving partnerships between basic and clinical investigators. (2) Evaluate opportunities for intervention studies to treat or prevent CVD in T1D. Because of practical obstacles (recruitment, duration, and cost of interventional studies with hard clinical end points), identification of reliable methods and markers that enable efficient intervention were a high priority. The meeting included 3 sessions: (1) current understanding of T1D and CVD; (2) opportunities to expand our understanding of the pathogenesis and clinical course of CVD in T1D; and (3) opportunities for intervention studies to reduce cardiovascular complications in T1D. This report summarizes the presentations made and concludes with recommendations drawn from the presentations and discussion among the participants. The epidemic of T2D in the United States has focused renewed attention on its complications. The complication causing greatest mortality and expense is CVD, responsible for 65% to 75% of deaths in the T2D population. T1D is comparatively uncommon and usually has its onset in younger populations. Although not associated with many of …

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