Insulin resistance-related factors, but not glycemia, predict coronary artery disease in type 1 diabetes: 10-year follow-up data from the Pittsburgh Epidemiology of Diabetes Complications Study.

OBJECTIVE To determine the independent risk factors for coronary artery disease (CAD) in type 1 diabetes by type of CAD at first presentation. RESEARCH DESIGN AND METHODS This is a historical prospective cohort study of 603 patients with type 1 diabetes diagnosed before 18 years of age between 1950 and 1980. The mean age and duration of diabetes at baseline were 28 (range 8-47) and 19 years (7-37), respectively, and patients were followed for 10 years. Patients with prevalent CAD were excluded from the study. Electrocardiogram (ECG) ischemia was defined by Minnesota Code (MC) 1.3, 4.1-3, 5.1-3, or 7.1; angina was determined by Pittsburgh Epidemiology of Diabetes Complications (EDC) study physician diagnosis; and hard CAD was determined by angiographic stenosis > or =50%, revascularization procedure, Q waves (MC 1.1-1.2), nonfatal myocardial infarction (MI), or CAD death. RESULTS A total of 108 incident CAD events occurred during the 10-year follow-up: 17 cases of ECG ischemia, 49 cases of angina, and 42 cases of hard CAD (5 CAD deaths, 25 nonfatal MI or major Q waves, and 12 revascularization or > or =50% stenosis). Blood pressure, lipid levels, inflammatory markers, renal disease, and peripheral vascular disease showed a positive gradient across the groups of no CAD, angina, and hard CAD (P < 0.01, trend analysis, all variables), although estimated glucose disposal rate (eGDR) and physical activity showed inverse associations (P < 0.01, trend analysis, both variables). In addition, depressive symptomatology predicted angina (P = 0.016), whereas HbA(1) showed no association with subsequent CAD. CONCLUSIONS These data suggest that although the standard CAD risk factors are still operative in type 1 diabetes, greater glycemia does not seem to predict future CAD events. In addition, depressive symptomatology predicts angina and insulin resistance (eGDR) predicts hard CAD end points.

[1]  M. Berger,et al.  Prolonged QT interval as a predictor of mortality in diabetic nephropathy , 1996, Diabetologia.

[2]  P. Andersen,et al.  The effect of proteinuria on relative mortality in Type 1 (insulin-dependent) diabetes mellitus , 1985, Diabetologia.

[3]  S. Kelsey,et al.  Subclinical atherosclerosis and estimated glucose disposal rate as predictors of mortality in type 1 diabetes. , 2002, Annals of epidemiology.

[4]  T. Orchard,et al.  Can clinical factors estimate insulin resistance in type 1 diabetes? , 2000, Diabetes.

[5]  Philip Greenland,et al.  Prevention Conference V Beyond Secondary Prevention : Identifying the High-Risk Patient for Primary Prevention : Executive Summary , 2000 .

[6]  L. Kuller,et al.  Are predictors of coronary heart disease and lower-extremity arterial disease in type 1 diabetes the same? A prospective study. , 2000, Atherosclerosis.

[7]  D Glogar,et al.  Coronary risk factors influence plaque morphology in patients with unstable angina. , 1999, Coronary artery disease.

[8]  Harry Hemingway,et al.  Evidence based cardiology: psychosocial factors in the aetiology and prognosis of coronary heart disease. Systematic review of prospective cohort studies. , 1999, BMJ.

[9]  M. Laakso,et al.  Poor glycemic control predicts coronary heart disease events in patients with type 1 diabetes without nephropathy. , 1999, Arteriosclerosis, thrombosis, and vascular biology.

[10]  K. Forrest,et al.  Cardiovascular disease in insulin dependent diabetes mellitus: similar rates but different risk factors in the US compared with Europe. , 1998, International journal of epidemiology.

[11]  P. Vokonas,et al.  Depression and the risk of coronary heart disease in the Normative Aging Study. , 1998, The American journal of cardiology.

[12]  P A Cleary,et al.  Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure: results from the DCCT. Diabetes Control and Complications Trial. , 1998, JAMA.

[13]  L. Kuller,et al.  The Association Between a Family History of Type 2 Diabetes and Coronary Artery Disease in a Type 1 Diabetes Population , 1998, Diabetes Care.

[14]  E. Barrett-Connor.  Does Hyperglycemia Really Cause Coronary Heart Disease? , 1997, Diabetes Care.

[15]  M. Davies.  The composition of coronary-artery plaques. , 1997, The New England journal of medicine.

[16]  M. Muggeo,et al.  Cardiovascular Disease and Its Risk Factors in IDDM in Europe , 1996, Diabetes Care.

[17]  L. Kuller,et al.  Coronary artery disease in IDDM. Gender differences in risk factors but not risk. , 1996, Arteriosclerosis, thrombosis, and vascular biology.

[18]  R. Bucala,et al.  Advanced glycosylation end products in diabetic renal and vascular disease. , 1995, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[19]  R. Klein.  Hyperglycemie and Microvascular and Macrovascular Disease in Diabetes , 1995, Diabetes Care.

[20]  P. Richter,et al.  PSYCHOMETRIC PROPERTIES OF THE BECK DEPRESSION INVENTORY , 1994 .

[21]  D. Strandness,et al.  Assessment of peripheral vascular disease in diabetes. Report and recommendations of an international workshop sponsored by the American Heart Association and the American Diabetes Association 18-20 September 1992, New Orleans, Louisiana. , 1993, Diabetes care.

[22]  D. Strandness,et al.  Assessment of Peripheral Vascular Disease in Diabetes: Report and Recommendations of an International Workshop Sponsored by the American Heart Association and the American Diabetes Association , 1993, Diabetes Care.

[23]  T. Orchard,et al.  Assessment of Peripheral Vascular Disease in Diabetes Report and Recommendations of an International Workshop* Sponsored by the American Diabetes Association and the American Heart Association September 18‐20, 1992 New Orleans, Louisiana , 1993, Circulation.

[24]  W. Roberts,et al.  Composition of atherosclerotic plaques in the epicardial coronary arteries in juvenile (type I) diabetes mellitus. , 1992, The American journal of cardiology.

[25]  T. Orchard,et al.  Diabetes Mellitus and Macrovascular Complications: An epidemiological perspective , 1992, Diabetes Care.

[26]  R. Paffenbarger,et al.  Time trends in physical activity among college alumni, 1962-1988. , 1992, American journal of epidemiology.

[27]  D. Clemmons.  Role of Peptide Growth Factors in Development of Macrovascular Complications of Diabetes , 1991, Diabetes Care.

[28]  L. Kuller,et al.  Prevalence of Complications in IDDM by Sex and Duration: Pittsburgh Epidemiology of Diabetes Complications Study II , 1990, Diabetes.

[29]  L. Kuller,et al.  Factors Associated With Avoidance of Severe Complications After 25 Yr of IDDM: Pittsburgh Epidemiology of Diabetes Complications Study I , 1990, Diabetes Care.

[30]  L. Kuller,et al.  Diabetic autonomic neuropathy and cardiovascular risk. Pittsburgh Epidemiology of Diabetes Complications Study III. , 1990, Archives of internal medicine.

[31]  Langford Hg.  The hypertension detection and follow-up program. , 1984 .

[32]  H. Langford.  The hypertension detection and follow-up program. , 1984, New York state journal of medicine.

[33]  P. Gartside,et al.  Estradiol, testosterone, apolipoproteins, lipoprotein cholesterol, and lipolytic enzymes in men with premature myocardial infarction and angiographically assessed coronary occlusion. , 1983, Artery.

[34]  D. Wagener,et al.  The Pittsburgh Study of Insulin-Dependent Diabetes Mellitus: Risk for Diabetes Among Relatives of IDDM , 1982, Diabetes.

[35]  Ronald J. Prineas,et al.  The Minnesota code manual of electrocardiographic findings : standards and procedures for measurement and classification , 1982 .

[36]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.