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Risk Factors for First and Subsequent CVD Events in Type 1 Diabetes: The DCCT/EDIC Study
- Source :
- Diabetes Care
- Publication Year :
- 2019
-
Abstract
- OBJECTIVE The Diabetes Control and Complications Trial (DCCT) and its observational follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) demonstrated the dominant role of glycemia, second only to age, as a risk factor for a first cardiovascular event in type 1 diabetes (T1D). We now investigate the association between established risk factors and the total cardiovascular disease (CVD) burden, including subsequent (i.e., recurrent) events. RESEARCH DESIGN AND METHODS CVD events in the 1,441 DCCT/EDIC participants were analyzed separately by type (CVD death, acute myocardial infarction [MI], stroke, silent MI, angina, percutaneous transluminal coronary angioplasty/coronary artery bypass graft [PTCA/CABG], and congestive heart failure [CHF]) or as composite outcomes (CVD or major adverse cardiovascular events [MACE]). Proportional rate models and conditional models assessed associations between risk factors and CVD outcomes. RESULTS Over a median follow-up of 29 years, 239 participants had 421 CVD events, and 120 individuals had 149 MACE. Age was the strongest risk factor for acute MI, silent MI, stroke, and PTCA/CABG, while glycemia was the strongest risk factor for CVD death, CHF, and angina, second strongest for acute MI and PTCA/CABG, third strongest for stroke, and not associated with silent MI. HbA1c was the strongest modifiable risk factor for a first CVD event (CVD: HR 1.38 [95% CI 1.21, 1.56] per 1% higher HbA1c; MACE: HR 1.54 [1.30, 1.82]) and also for subsequent CVD events (CVD: incidence ratio [IR] 1.28 [95% CI 1.09, 1.51]; MACE: IR 1.89 [1.36, 2.61]). CONCLUSIONS Intensive glycemic management is recommended to lower the risk of initial CVD events in T1D. After a first event, optimal glycemic control may reduce the risk of recurrent CVD events and should be maintained.
- Subjects :
- Adult
Blood Glucose
Male
medicine.medical_specialty
Cardiovascular and Metabolic Risk
Endocrinology, Diabetes and Metabolism
030209 endocrinology & metabolism
Angina
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
Diabetes mellitus
Internal Medicine
Medicine
Humans
Hypoglycemic Agents
030212 general & internal medicine
Myocardial infarction
cardiovascular diseases
Risk factor
Stroke
Advanced and Specialized Nursing
Type 1 diabetes
business.industry
Incidence
Middle Aged
medicine.disease
Diabetes Mellitus, Type 1
Treatment Outcome
Cardiovascular Diseases
Heart failure
Cardiology
Female
business
Mace
Diabetic Angiopathies
Follow-Up Studies
Subjects
Details
- ISSN :
- 19355548
- Volume :
- 43
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Diabetes care
- Accession number :
- edsair.doi.dedup.....26a5e348b982355120edc2195b50bf5a