Risk factors for cardiovascular disease (CVD) in adults with type 1 diabetes: findings from prospective real-life T1D exchange registry

Context Cardiovascular disease (CVD) is a major cause of mortality in
adults with type 1 diabetes. Objective We prospectively evaluated CVD risk
factors in a large, contemporary cohort of adults with type 1 diabetes
living in the United States. Design Observational study of CVD and CVD
risk factors over a median of 5.3 years. Setting The T1D Exchange clinic
network. Patients Adults (age ≥18 years) with type 1 diabetes and without
known CVD diagnosed before or at enrollment. Main Outcome Measure
Associations between CVD risk factors and incident CVD were assessed by
multivariable logistic regression. Results The study included 8,727
participants (53% female, 88% non-Hispanic white, median age 33 years
[IQR=21, 48], type 1 diabetes duration 16 years [IQR=9, 26]). At
enrollment, median HbA1c was 7.6% (66 mmol/mol) [IQR=6.9 (52), 8.6 (70)],
33% used a statin, and 37% used blood pressure medication. Over a mean
follow-up of 4.6 years, 325 (3.7%) participants developed incident CVD.
Ischemic heart disease was the most common CVD event. Increasing age, BMI,
HbA1c, presence of hypertension and dyslipidemia, increasing duration of
diabetes, and diabetic nephropathy were associated with increased risk for
CVD. There were no significant gender differences in CVD risk. Conclusion
HbA1c, hypertension, dyslipidemia and diabetic nephropathy are important
risk factors for CVD in adults with type 1 diabetes. A longer follow-up is
likely required to assess the impact of other traditional CVD risk factors
on incident CVD in the current era.

背景：心血管疾病（Cardiovascular disease, CVD）是1型糖尿病（type 1 diabetes）成人患者的主要致死原因。
研究目的：本研究前瞻性评估了美国境内大型当代1型糖尿病成人队列的心血管疾病危险因素。
研究设计：一项针对心血管疾病及其危险因素的观察性研究，中位随访时长为5.3年。
研究场景：T1D Exchange诊所网络。
研究对象：纳入年龄≥18岁、罹患1型糖尿病且入组前或入组时未确诊心血管疾病的成人受试者。
主要结局指标：通过多变量logistic回归（multivariable logistic regression）分析评估心血管疾病危险因素与新发心血管疾病之间的关联。
研究结果：本研究共纳入8727名受试者，其中53%为女性，88%为非西班牙裔白人，中位年龄33岁[IQR=21, 48]，1型糖尿病病程中位值为16年[IQR=9, 26]。入组时，受试者的糖化血红蛋白（HbA1c）中位值为7.6%（66 mmol/mol）[IQR=6.9(52), 8.6(70)]，33%的受试者使用他汀类药物，37%使用降压药物。在平均4.6年的随访期间，共有325名（3.7%）受试者发生新发心血管疾病，其中缺血性心脏病是最常见的心血管事件。年龄、BMI、HbA1c升高、合并高血压与血脂异常、糖尿病病程延长以及糖尿病肾病均与心血管疾病风险升高相关，未观察到显著的性别相关心血管疾病风险差异。
研究结论：糖化血红蛋白（HbA1c）、高血压、血脂异常与糖尿病肾病是1型糖尿病成人患者发生心血管疾病的重要危险因素。在当前时代，可能需要更长的随访时长以评估其他传统心血管疾病危险因素对新发心血管疾病的影响。