Abstract
The incidence of nephropathy, a major predictor of coronary artery disease (CAD) in type 1 diabetes (T1D), has been strongly declining over the past several years. However, CAD rates do not appear to be declining commensurately. To identify similarities and differences in the CAD risk factor profile in subjects with and without microalbuminuria or worse (MA+), 20 year follow up data from the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood onset T1D (mean baseline age 28 and duration 19 yrs) were examined. MA+ was determined by kidney disease-related death, dialysis, transplant, or AER>20 μg/mL in 2 of 3 timed urine collections. CAD was defined as angina, ischemic ECG changes, revascularization, confirmed MI, or CAD death. Cox proportional hazard models, adjusted for all the significant univariate risk factors, were determined separately for subjects who developed MA+ before their incident CAD event and for those who had CAD without preceding MA (MA-). As we have previously shown that CAD risk factors to vary by sex, we performed sex specific analyses within each MA group to determine if the predictors of CAD differ by sex and MA status. The results of the sex-specific analysis are listed in the table below. MA- MA+ Men (n=15 cases/84 β (CI) Men (n=65 cases/165) β (CI) nonHDL (mg/dl) 1.02 (1.0-1.04) Diabetes Duration (years) 1.12 (1.1-1.2) WHR 3.05 (.98-9.5) AER (log) 1.34 (1.2-1.5) Women (n=20 cases/92) Women (n=56 cases/172) Diabetes Duration (years) 1.11 (1.0-1.2) Diabetes Duration (years) 1.11 (1.07-1.15) Pulse Rate (bpm) 1.06 (1.0-1.1) Hypertension 1.85 (1.0-3.2) nonHDL (mg/dl) 1.01 (1.0-1.01) In the MA+ group, diabetes duration predicted CAD in both sexes, with AER (men) and hypertension and nonHDL (women) also contributing. However, in the MA- group, duration was only predictive in women, where pulse rate (p=0.016) was also predictive, while in men nonHDL, and to a small extent WHR (p=.054) predicted CAD. In conclusion, these data suggest that further factors beyond standard risk factors and renal disease are operative in T1D, particularly pulse rate in women.
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