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Atherosclerosis and Microvascular Complications: Results From the Canadian Study of Longevity in Type 1 Diabetes

Julie A Lovshin1,2, Petter Bjornstad3,4, Leif E Lovblom5

  • 1Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada julie.lovshin@sunnybrook.ca.

Diabetes Care
|October 3, 2018
PubMed

Insights

In adults with type 1 diabetes, high coronary artery calcification (CAC) was linked to neuropathy and retinopathy, but not diabetic kidney disease. This suggests shared risk factors for these conditions.

Area of Science:

  • Cardiology
  • Endocrinology
  • Nephrology

Background:

  • Type 1 diabetes significantly increases cardiovascular mortality risk.
  • The relationship between atherosclerosis and microvascular complications in type 1 diabetes is not fully understood.
  • Longstanding type 1 diabetes (≥50 years) poses unique challenges for cardiovascular and microvascular health.

Purpose of the Study:

  • To investigate the association between atherosclerotic burden, measured by coronary artery calcification (CAC) volume scoring, and microvascular complications.
  • To determine if diabetic kidney disease (DKD), neuropathy, and retinopathy are related to CAC in adults with long-standing type 1 diabetes.

Main Methods:

  • Sixty-nine adults with type 1 diabetes underwent CAC scoring via computed tomography.
  • Microvascular complications (neuropathy, retinopathy, DKD) were assessed using various clinical and imaging techniques.
  • A comparator group of 73 individuals without diabetes, matched for age and sex, was included.

Main Results:

  • Participants with type 1 diabetes had significantly higher CAC scores compared to the comparator group (median 1,000 AU vs. 1 AU, P < 0.001).
  • High CAC scores in the type 1 diabetes cohort were associated with neuropathy and retinopathy.
  • No significant association was found between high CAC scores and DKD or renal hemodynamic function.

Conclusions:

  • High coronary artery calcification in adults with long-standing type 1 diabetes is associated with large nerve fiber neuropathy and retinopathy.
  • These findings suggest that neuropathy, retinopathy, and macrovascular calcification may share common underlying risk factors.
  • Further research is needed to elucidate the specific shared mechanisms and inform targeted interventions.
Abstract

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