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Glycaemic control and excess risk of major coronary events in persons with type 1 diabetes

Viktorija Matuleviciene-Anängen1, Annika Rosengren1, Ann-Marie Svensson2

  • 1Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.

Heart (British Cardiac Society)
|July 16, 2017
PubMed

Insights

Individuals with type 1 diabetes (T1D) face a higher risk of major coronary events. This risk is significantly reduced with good glycemic control and absence of kidney complications, particularly in men.

Area of Science:

  • Cardiovascular epidemiology
  • Diabetes mellitus research
  • Renal complications in diabetes

Background:

  • Type 1 diabetes (T1D) is associated with an increased risk of cardiovascular events.
  • The specific impact of glycemic control and renal complications on this excess risk in T1D is not well-defined.

Purpose of the Study:

  • To investigate the excess risk of major coronary events (acute myocardial infarction or coronary heart disease death) in individuals with T1D.
  • To analyze how glycemic control and renal complications influence this excess risk.

Main Methods:

  • A cohort study using the Swedish National Diabetes Registry (2009-2011).
  • Included individuals with T1D (n=33,170) and matched controls (n=1,649,698).
  • Follow-up for non-fatal acute myocardial infarction or coronary heart disease death.

Main Results:

  • Individuals with T1D had an adjusted hazard ratio of 4.07 for major coronary events compared to controls.
  • Excess risk increased with younger age, female sex, poorer glycemic control (higher HbA1c), and more severe renal complications.
  • For men with T1D, HbA1c <6.9% and normoalbuminuria had an adjusted HR of 1.30; this increased to 10.7 with HbA1c >9.7% and renal complications.

Conclusions:

  • The excess risk of acute myocardial infarction in T1D is significantly lower with good glycemic control, no renal complications, and in men.
  • Women with T1D experience a persistent excess risk of acute myocardial infarction or coronary heart disease death, even with good glycemic control and no renal complications.
Abstract

Keywords:
blood glucosecoronary diseasediabetes complicationsdiabetes mellitusmyocardial infarctiontype1

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