@article{069023480d0e40d0a3064b2270ae67f8,
title = "Associations of Microvascular Complications With the Risk of Cardiovascular Disease in Type 1 Diabetes",
abstract = "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.",
author = "Rose Gubitosi-Klug and Xiaoyu Gao and Rodica Pop-Busui and {de Boer}, {Ian H.} and Neill White and Aiello, {Lloyd P.} and Ryan Miller and Jerry Palmer and William Tamborlane and Amisha Wallia and Mikhail Kosiborod and Lachin, {John M.} and Ionut Bebu",
note = "Funding Information: Funding. The DCCT/EDIC has been supported by cooperative agreement grants (1982–1993, 2012–2017, and 2017–2022) and contracts (1982–2012) with the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (current grants U01 DK094176 and U01 DK094157), and through support from the National Eye Institute, the National Institute of Neurologic Disorders and Stroke, the General Clinical Research Centers Program (1993–2007), and Clinical Translational Science Center Program (2006–present), Bethesda, MD. Industry contributors have had no role in the DCCT/EDIC study but have provided free or discounted supplies or equipment to support participants{\textquoteright} adherence to the study: Abbott Diabetes Care (Alameda, CA), Animas (Westchester, PA), Bayer Diabetes Care (Tarrytown, NY), Becton Dickinson (Franklin Lakes, NJ), Eli Lilly and Company (Indianapolis, IN), Extend Nutrition (St. Louis, MO), Insulet Corporation (Bedford, MA), Life-Scan (Milpitas, CA), Medtronic Diabetes (Minneapolis, MN), Nipro Home Diagnostics (Ft. Lauderdale, FL), Nova Diabetes Care (Billerica, MA), Omron (Shelton, CT), Perrigo Diabetes Care (Allegan, MI), Roche Diabetes Care (Indianapolis, IN), and Sanofi (Bridgewater, NJ). Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. R.G.-K., J.M.L., and I.B. designed the study. R.G.-K. wrote the initial draft of the manuscript. X.G. conducted all analyses under the supervision of I.B. The other authors contributed to the specification of the analyses and critically reviewed and edited the manuscript. I.B. is the guarantor of this work and, as such, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Publisher Copyright: {\textcopyright} 2021 by the American Diabetes Association.",
year = "2021",
month = jul,
doi = "10.2337/DC20-3104",
language = "English (US)",
volume = "44",
pages = "1499--1505",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "7",
}
