© 1999 American Heart Association, Inc.
Original Contributions |
Poor Glycemic Control Predicts Coronary Heart Disease Events in Patients With Type 1 Diabetes Without Nephropathy
From the Department of Medicine (S.L., K.P., M.L.), Kuopio University Hospital, Kuopio; and the Department of Medicine (T.R.), Turku University Central Hospital, and the Social Insurance Institution (T.R.), Turku, Finland.
Correspondence to M. Laakso, Department of Medicine, Kuopio University Hospital, SF-70210 Kuopio, Finland. E-mail markku.laakso{at}uku.fi
Abstract—Patients with type 1
diabetes mellitus, especially those with nephropathy, are
at increased risk for coronary heart disease (CHD). However,
information on the predictive value of cardiovascular
risk factors and the degree of hyperglycemia with respect to CHD events
in patients with type 1 diabetes without nephropathy is
still incomplete. Therefore, we performed a prospective study on risk
factors for CHD in patients with type 1 diabetes free of clinical
nephropathy. At baseline examination,
cardiovascular risk factor levels of CHD were
determined in 177 patients with type 1 diabetes (87 men and 90 women),
age 45 to 64 years at baseline and 
30 years at the time of diagnosis
of diabetes. These patients were followed up to 7 years with respect to
CHD events. Altogether, 20 patients with type 1 diabetes (13 men
[7.3%] and 7 women [3.9%]) died of CHD and 28 patients with type
1 diabetes (17 men [9.6%] and 11 women [6.2%]) had a serious CHD
event (death from CHD or nonfatal myocardial infarction). In
multivariate Cox regression analysis, a
previous history of myocardial infarction (hazard ratio [HR]
and its 95% confidence interval, 8.0 [3.1 to 21.0],
P<0.001), high glycohemoglobin A1
(>10.4%, the highest tertile, HR 5.4 [1.4 to 20.4],
P=0.013), and the duration of diabetes (>16
years, the highest tertile, HR 4.2 [1.3 to 12.9],
P=0.013) were the only variables associated with CHD
death even after adjustment for other cardiovascular
risk factors. These variables also predicted the incidence of all
CHD events. Our results indicate that poor metabolic
control is a strong predictor of CHD events in patients with late-onset
type 1 diabetes without nephropathy, independently of other
cardiovascular risk factors.
Key Words: type 1 diabetes • glucose • glycohemoglobin A1 • coronary heart disease
This article has been cited by other articles:
 |
|
 |
|
  J. Waden, C. Forsblom, L. M. Thorn, D. Gordin, M. Saraheimo, P.-H. Groop, and on behalf of the Finnish Diabetic Nephropathy Stud A1C Variability Predicts Incident Cardiovascular Events, Microalbuminuria, and Overt Diabetic Nephropathy in Patients With Type 1 Diabetes Diabetes, November 1, 2009; 58(11): 2649 - 2655. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Conway, T. Costacou, and T. Orchard Is glycaemia or insulin dose the stronger risk factor for coronary artery disease in type 1 diabetes? Diabetes and Vascular Disease Research, October 1, 2009; 6(4): 223 - 230. [Abstract] [PDF]
|
|
|
|
 |
|
 J. W. M. Cheng, S. H. Bhatt, and J. D. Goldman-Levine The Benefit and Risk of Antidiabetic Agents Used in Patients With Heart Disease Journal of Pharmacy Practice, April 1, 2009; 22(2): 179 - 193. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Shankar, R. Klein, B. E. K. Klein, and S. E. Moss Association between Glycosylated Hemoglobin Level and Cardiovascular and All-Cause Mortality in Type 1 Diabetes Am. J. Epidemiol., August 15, 2007; 166(4): 393 - 402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Cleary, T. J. Orchard, S. Genuth, N. D. Wong, R. Detrano, J.-Y. C. Backlund, B. Zinman, A. Jacobson, W. Sun, J. M. Lachin, et al. The Effect of Intensive Glycemic Treatment on Coronary Artery Calcification in Type 1 Diabetic Participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Diabetes, December 1, 2006; 55(12): 3556 - 3565. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. J. Orchard, T. Costacou, A. Kretowski, and R. W. Nesto Type 1 diabetes and coronary artery disease. Diabetes Care, November 1, 2006; 29(11): 2528 - 2538. [Full Text] [PDF]
|
|
|
|
 |
|
 The Diabetes Control and Complications Trial/Epide Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 Diabetes N. Engl. J. Med., December 22, 2005; 353(25): 2643 - 2653. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Selvin, S. Marinopoulos, G. Berkenblit, T. Rami, F. L. Brancati, N. R. Powe, and S. H. Golden Meta-Analysis: Glycosylated Hemoglobin and Cardiovascular Disease in Diabetes Mellitus Ann Intern Med, September 21, 2004; 141(6): 421 - 431. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Soedamah-Muthu, N. Chaturvedi, M. Toeller, B. Ferriss, P. Reboldi, G. Michel, C. Manes, and J. H. Fuller Risk Factors for Coronary Heart Disease in Type 1 Diabetic Patients in Europe: The EURODIAB Prospective Complications Study Diabetes Care, February 1, 2004; 27(2): 530 - 537. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. J. Orchard, J. C. Olson, J. R. Erbey, K. Williams, K. Y.-Z. Forrest, L. Smithline Kinder, D. Ellis, and D. J. Becker 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 Diabetes Care, May 1, 2003; 26(5): 1374 - 1379. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Larsen, M. Brekke, L. Sandvik, H. Arnesen, K. F. Hanssen, and K. Dahl-Jorgensen Silent Coronary Atheromatosis in Type 1 Diabetic Patients and Its Relation to Long-Term Glycemic Control Diabetes, August 1, 2002; 51(8): 2637 - 2641. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. T. Bloomgarden European Association for the Study of Diabetes (EASD) 2001 Meeting Diabetes Care, July 1, 2002; 25(7): 1229 - 1236. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Westerbacka, A. Uosukainen, S. Makimattila, A. Schlenzka, and H. Yki-Jarvinen Insulin-Induced Decrease in Large Artery Stiffness Is Impaired in Uncomplicated Type 1 Diabetes Mellitus Hypertension, May 1, 2000; 35(5): 1043 - 1048. [Abstract] [Full Text] [PDF]
|
|