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Cardiovascular disease and its risk factors in IDDM in Europe. EURODIAB IDDM Complications Study Group
V A Koivisto1, L K Stevens, M Mattock
1Department of Medicine, Helsinki University Hospital, Finland.
Insights
Cardiovascular disease (CVD) affects about 10% of patients with insulin-dependent diabetes mellitus (IDDM), increasing with age and diabetes duration. Key risk factors include high triglycerides and low HDL cholesterol.
Area of Science:
- Endocrinology
- Cardiology
- Epidemiology
Background:
- Cardiovascular disease (CVD) is a significant complication in patients with insulin-dependent diabetes mellitus (IDDM).
- Understanding the prevalence and risk factors of CVD in IDDM is crucial for effective management and prevention strategies across diverse European populations.
Purpose of the Study:
- To investigate the prevalence of cardiovascular disease (CVD) in patients with insulin-dependent diabetes mellitus (IDDM) across various European countries.
- To identify and analyze the risk factors associated with CVD in this patient cohort.
Main Methods:
- A cross-sectional study involving 3,250 IDDM patients from 16 European countries (EURODIAB IDDM Complications Study).
- Data collected from 31 centers, stratified by age, sex, and diabetes duration (mean 14.7 years).
- Prevalence of CVD (history or ECG abnormalities) and risk factors were assessed.
Main Results:
- Overall CVD prevalence was approximately 10% (9% in men, 10% in women), increasing with age and diabetes duration.
- Significant between-center variation (3-19%) was observed.
- Elevated triglycerides and reduced HDL cholesterol were strongly associated with CVD. In men, longer diabetes duration, higher waist-to-hip ratio, and hypertension were linked to CVD. In women, higher BMI was associated with increased CVD prevalence.
Conclusions:
- CVD prevalence in IDDM patients is around 10%, rising with age and diabetes duration, with substantial geographic variation.
- Lipid profiles (triglycerides, HDL cholesterol) are key indicators for CVD risk.
- Waist-to-hip ratio is a significant marker for metabolic syndrome in IDDM, particularly in men.
Objective:
To study the prevalence of cardiovascular disease (CVD), its risk factors, and their associations in IDDM patients in different European countries.
Research Design And Methods:
The prevalence of CVD (a past history or electrocardiogram abnormalities) and its risk factors were examined in a cross-sectional study in 3,250 IDDM patients from 16 European countries (EURODIAB IDDM Complications Study). The patients were examined in 31 centers and were stratified between centers for age, sex, and duration of diabetes. The mean +/- SD duration of diabetes was 14.7 +/- 9.3 years.
Results:
The prevalence of CVD was 9% in men and 10% in women. The prevalence increased with age (from 6% in patients 15-29 years old to 25% in patients 45-59 years old) and with duration of diabetes. The between-center variation for the whole population was from 3 to 19%. In both sexes, fasting triglyceride concentration was higher and HDL cholesterol lower in those patients with CVD than in those without. In men, duration of diabetes was longer, waist-to-hip ratio greater, and hypertension more common in patients with CVD. In women, a greater BMI was associated with increased prevalence of CVD. There was no association between insulin dose, HbA1c level, age-adjusted rate of albumin excretion, or smoking status and CVD. Waist-to-hip ratio, particularly in men, was positively associated with age, age-adjusted HbA1c, prevalence of smoking, daily insulin dose, albumin excretion rate, and fasting triglyceride concentrations.
Conclusions:
The overall prevalence of CVD in these IDDM patients was approximately 10%, increasing with age and duration of diabetes and with a sixfold variation between different European centers. CVD prevalence was most strongly associated with elevated triglyceride and decreased HDL cholesterol concentrations. CVD was also associated with albuminuria, but when adjusted by age, this association vanished. Increasing waist-to-hip ratio was associated with a number of adverse characteristics, particularly in IDDM men, reflecting the metabolic syndrome previously described in other populations.