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Undiagnosed coronary artery disease in long-term type 1 diabetes. The Dialong study

Kristine Bech Holte1, Mona Svanteson2, Kristian Folkvord Hanssen3

  • 1Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.

Journal of Diabetes and Its Complications
|March 9, 2019
PubMed

Insights

Long-term type 1 diabetes (T1D) survivors have a high prevalence of undiagnosed obstructive coronary artery disease (CAD). Poor glycemic control (HbA1c) and high LDL cholesterol are linked to CAD development in T1D.

Area of Science:

  • Cardiology
  • Endocrinology
  • Diabetology

Background:

  • Type 1 diabetes (T1D) is associated with an increased risk of cardiovascular complications.
  • Long-term T1D survivors may face a higher burden of coronary artery disease (CAD).
  • Understanding CAD prevalence and risk factors in T1D is crucial for preventative strategies.

Purpose of the Study:

  • To determine the prevalence of obstructive CAD, undiagnosed CAD, and absent CAD in long-term T1D patients compared to controls.
  • To investigate the association of mean HbA1c, LDL-cholesterol, and blood pressure over 2-3 decades with CAD in T1D.
  • To assess CAD in individuals with a T1D duration of at least 45 years.

Main Methods:

  • A cohort of T1D patients diagnosed before 1970 and age- and sex-matched controls were included.
  • Longitudinal data (20-30 years) on HbA1c, LDL-cholesterol, and blood pressure were collected.
  • Computed Tomography Coronary Angiography (CTCA) was used to assess coronary stenosis in participants without prior diagnoses.

Main Results:

  • The prevalence of undiagnosed obstructive CAD was significantly higher in T1D patients (24%) compared to controls (10%).
  • Absent CAD was more common in controls (50%) than in T1D patients (16%).
  • Elevated mean HbA1c was associated with undiagnosed obstructive CAD (OR 2.30), and mean LDL-cholesterol was inversely associated with absent CAD (OR 0.12).

Conclusions:

  • A substantial proportion (24%) of long-term T1D survivors exhibit undiagnosed obstructive CAD.
  • Mean HbA1c and LDL-cholesterol levels are significant predictors of CAD in individuals with long-standing T1D.
  • These findings highlight the importance of rigorous cardiovascular risk factor management in T1D.
Abstract

Keywords:
Cholesterol, LDLComputer Tomography AngiographyCoronary artery diseaseDiabetes mellitus, type 1Glycated Hemoglobin A

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