© 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
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