Uric Acid and Cardiovascular Disease in Type 1 Diabetes

Abstract

Background: Serum uric acid (UA) is associated with the pathogenesis of diabetes complications, including cardiovascular disease (CVD) and kidney injury. Current epidemiological evidence is limited regarding the association between UA and the development of CVD in type 1 diabetes mellitus (T1DM). Objective: To examine associations of serum UA with CVD and major atherosclerotic cardiovascular events (MACE) in T1DM. Methods: UA was measured in sera (1997-2000) from a subset of participants (n=973; males=540, females=433) in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Subsequent CVD events were adjudicated by a review committee masked to DCCT assignment and HbA1c levels, and defined as the time to the first of any of the following: non-fatal myocardial infarction (MI) or stroke, CVD death, silent MI on annual ECG, angina confirmed by ischemic changes with exercise tolerance testing, congestive heart failure, or revascularization; MACE were defined as a composite of CVD death, nonfatal MI, or stroke. Cox proportional hazards models were used to evaluate prospectively the effect of UA as a fixed covariate on CVD and MACE, separately by gender, and adjusted for age and HbA1c. Results: Over 15 years follow-up, there were 201 adjudicated CVD events among 110 participants (HR=1.10 per 1 mg/dl change in UA, 95% CI 0.93-1.30); 61 males experienced 96 events (HR=1.15, 95% CI 0.90-1.46) and 49 females, 105 events (HR=1.17, 95% CI 0.88-1.56). There were 62 adjudicated MACE among 53 participants (HR=1.18, 95% CI 0.93-1.49); 29 males experienced 31 events (HR=1.10, 95% CI 0.77-1.58) and 24 females, 31 events (HR=1.47, 95% CI 1.01-2.14). No significant associations between quartiles of UA and either CVD or MACE were observed in either sex. Conclusions: Our results show UA may not serve as a predictive biomarker for CVD events in T1DM adults. Sex-specific associations with MACE deserve further investigation. Disclosure A. Basu: None. B. Braffett: None. A. Jenkins: Research Support; Self; Medtronic, Mylan, Sanofi-Aventis. I. Bebu: None. R.L. Klein: None. M.F. Lopes-Virella: None. S. Dagogo-Jack: None. T.J. Orchard: None. A. Wallia: Research Support; Self; UnitedHealth Group. Consultant; Self; Glytec Systems, Lexicon Pharmaceuticals, Inc.. Research Support; Self; Eli Lilly and Company. J. Lachin: Board Member; Self; AbbVie Inc., Celgene Corporation. W. Garvey: Advisory Panel; Self; Novo Nordisk Inc., Merck & Co., Inc.. Research Support; Self; Sanofi, Pfizer Inc., Novo Nordisk Inc., AstraZeneca, Merck & Co., Inc., Elcelyx Therapeutics, Inc., Lexicon Pharmaceuticals, Inc., Eisai Inc.. T. Lyons: None.