Associations of Microvascular Complications With the Risk of Cardiovascular Disease in Type 1 Diabetes

Rose Gubitosi-Klug, Xiaoyu Gao, Rodica Pop-Busui, Ian H. de Boer, Neill White, Lloyd P. Aiello, Ryan Miller, Jerry Palmer, William Tamborlane, Amisha Wallia, Mikhail Kosiborod, John M. Lachin, Ionut Bebu*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


OBJECTIVE We examined whether the presence of microvascular complications was associated with increased subsequent risk of cardiovascular disease (CVD) among participants with type 1 diabetes in the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study fol-lowed for >35 years. RESEARCH DESIGN AND METHODS Standardized longitudinal data collection included: 1) stereoscopic seven-field retinal fundus photography centrally graded for retinopathy stage and clinically significant macular edema; 2) urinary albumin excretion rate (AER) and estimated glomerular filtration rate (eGFR); 3) cardiovascular autonomic neuropathy (CAN) reflex testing; and 4) adjudicated CVD events, including death from CVD, nonfatal myocardial infarction, stroke, subclinical myocardial infarction on electrocardio-gram, confirmed angina, or coronary artery revascularization. Cox proportional hazards models assessed the association of microvascular complications with subsequent risk of CVD. RESULTS A total of 239 participants developed CVD, including 120 participants who suffered major adverse cardiovascular events (MACE) defined as nonfatal myo-cardial infarction, nonfatal stroke, or cardiovascular death. The presence of microvascular disease (diabetic retinopathy, kidney disease, or CAN) was associated with increased risk of subsequent CVD and MACE (hazard ratios 1.86 to 3.18 and 2.09 to 3.63, respectively), associations that remained significant after adjusting for age and HbA1c. After adjustment for traditional CVD risk factors, however, only sus-tained AER ≥30 mg/24 h occurring alone and/or with eGFR <60 mL/min/1.73 m2 and the presence of both retinal and kidney disease remained associated with CVD. CONCLUSIONS Advanced microvascular disease, especially moderate to severe albuminuria or eGFR <60 mL/min/1.73 m2, conveyed an increased risk of subsequent cardiovascular disease in the DCCT/EDIC cohort.

Original languageEnglish (US)
Pages (from-to)1499-1505
Number of pages7
JournalDiabetes care
Issue number7
StatePublished - Jul 2021

ASJC Scopus subject areas

  • Advanced and Specialized Nursing
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


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