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Relationship between ABO blood groups and cardiovascular disease in type 1 diabetes according to diabetic nephropathy
Erika B Parente1,2,3,4, Valma Harjutsalo1,3,4,5, Markku Lehto1,3,4
1Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
Insights
Individuals with type 1 diabetes and microalbuminuria have an increased risk of ischemic heart disease (IHD) if they have blood group A. This finding highlights a specific risk factor for cardiovascular disease in this patient population.
Area of Science:
- Cardiovascular research
- Endocrinology
- Genetics
Background:
- ABO blood groups are linked to cardiovascular disease (CVD) risk in the general population.
- Type 1 diabetes and its complication, diabetic nephropathy (DN), are significant risk factors for CVD.
- The interplay between ABO blood groups, DN, and CVD in type 1 diabetes requires further investigation.
Purpose of the Study:
- To examine the association between ABO blood groups and CVD risk in individuals with type 1 diabetes.
- To determine if diabetic nephropathy status modifies the relationship between ABO blood groups and CVD.
- To identify specific ABO blood groups that may confer increased CVD risk in type 1 diabetes patients with DN.
Main Methods:
- A cohort of 4531 adults with type 1 diabetes from the FinnDiane Study was analyzed.
- Diabetic nephropathy (DN) was defined by urinary albumin excretion rate.
- Cardiovascular disease (CVD) events were tracked via national health registers, with analysis using multivariable Cox regression.
Main Results:
- Blood group A was associated with a higher risk of ischemic heart disease (IHD) compared to blood group O in patients with microalbuminuria.
- The elevated IHD risk in blood group A was specific to individuals with microalbuminuria and not observed in those with normoalbuminuria.
- No significant differences in the risk of ischemic stroke (IS) or peripheral artery disease (PAD) were found among ABO blood groups, irrespective of DN status.
Conclusions:
- Blood group A is identified as a risk factor for ischemic heart disease (IHD) in type 1 diabetes patients who also have microalbuminuria.
- This finding suggests that ABO blood group may play a role in the development of specific cardiovascular complications in diabetic nephropathy.
- Further research is warranted to elucidate the mechanisms underlying this association and its clinical implications.
Background:
ABO blood groups have previously been associated with cardiovascular disease (CVD) in the general population. This study aimed to investigate the potential relationship between ABO blood groups and CVD in individuals with type 1 diabetes according to diabetic nephropathy (DN) status.
Methods:
Adults with type 1 diabetes (4531 individuals) from the FinnDiane Study were evaluated. DN was determined by two out of three measurements of urinary albumin excretion rate. Albuminuria was defined as an excretion rate above 20 µg/min. CVD events were identified by linking the data with the Finnish Care Register for Health Care and the Finnish Cause of Death Register. Follow-up ranged from the baseline visit until a CVD event, death or the end of 2017. The impact of ABO blood groups on CVD risk was estimated by multivariable Cox-regression analyses adjusted for traditional risk factors.
Results:
At baseline, the median age was 38.5 (IQR 29.2-47.9) years, 47.5% were female and median duration of diabetes was 20.9 (11.4-30.7) years. There were 893 incident ischemic heart disease (IHD) events, 301 ischemic strokes (IS), and 415 peripheral artery disease (PAD) events during a median follow up of 16.5 (IQR 12.8-18.6) years. The A blood group showed the highest risk of IHD versus the O blood group, when microalbuminuria was present. Comparing the population with microalbuminuria with those with normoalbuminuria, only the A blood group elevated the risk of IHD. This increased risk was neither explained by the FUT2 secretor phenotype nor by the A-genotype distribution. The risk of IS or PAD was no different among the ABO blood groups regardless of diabetic nephropathy stage.
Conclusion:
The A blood group is a risk factor for IHD in individuals with type 1 diabetes and microalbuminuria.
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