Differential association of microvascular attributions with cardiovascular disease in patients with long duration of type 1 diabetes

TY - JOUR

T1 - Differential association of microvascular attributions with cardiovascular disease in patients with long duration of type 1 diabetes

AU - Gordin, Daniel

AU - Harjutsalo, Valma

AU - Tinsley, Liane

AU - Fickweiler, Ward

AU - Sun, Jennifer K.

AU - Forsblom, Carol

AU - Amenta, Peter S.

AU - Pober, David

AU - D'Eon, Stephanie

AU - Khatri, Maya

AU - Stillman, Isaac E.

AU - Groop, Per Henrik

AU - Keenan, Hillary A.

AU - King, George L.

N1 - Publisher Copyright: © 2018 by the American Diabetes Association.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - OBJECTIVE Independent association of chronic kidney disease (CKD) and proliferative diabetic retinopathy (PDR)with cardiovascular disease (CVD) has not been established. In the Joslin 50-Year Medalist study, characterizing individuals with type 1 diabetes for 50 years or more, we examined the associations of CKD and PDR with CVD, which was validated by another cohort with type 1 diabetes from Finland. RESEARCH DESIGN AND METHODS This cross-sectional study characterized U.S. residents (n = 762) with type 1 diabetes of 50 years or longer (Medalists) at a single site by questionnaire, clinical, ophthalmic, and laboratory studies. A replication cohort (n = 675) from the longitudinal Finnish Diabetic Nephropathy Study (FinnDiane) was used. CKD and PDR were defined as estimated glomerular filtration rate <45 mL/min/1.73m2 (CKD stage 3b) and accorDing to the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol, respectively. CVDwas based on questionnaires and/or hospital discharge registers. Associations of CVD status with CKD and PDR were analyzed by multivariable logistic regression. RESULTS CVD prevalence in the Medalists with CKD and without PDR (+CKD/2PDR) (n = 30) and CVD prevalence in the 2CKD/+PDR group (n = 339) were half the prevalence in the +CKD/+PDR group (n = 66) (34.5% and 42.8%vs. 68.2%, P = 0.002). PDR statuswas independently associated with CVD (odds ratio 0.21 [95% CI 0.08-0.58], P = 0.003) in patients with CKD. Among the Finnish cohort, a trend toward a lower prevalence of CVD in the +CKD/2PDR group (n = 21) compared with the +CKD/+PDR group (n=170) (19.1% vs. 37.1%, P = 0.10) was also observed. CONCLUSIONS Absence of PDR in people with type 1 diabetes and CKD was associated with a decreased prevalence of CVD, suggesting that common protective factors for PDR and CVD may exist.

AB - OBJECTIVE Independent association of chronic kidney disease (CKD) and proliferative diabetic retinopathy (PDR)with cardiovascular disease (CVD) has not been established. In the Joslin 50-Year Medalist study, characterizing individuals with type 1 diabetes for 50 years or more, we examined the associations of CKD and PDR with CVD, which was validated by another cohort with type 1 diabetes from Finland. RESEARCH DESIGN AND METHODS This cross-sectional study characterized U.S. residents (n = 762) with type 1 diabetes of 50 years or longer (Medalists) at a single site by questionnaire, clinical, ophthalmic, and laboratory studies. A replication cohort (n = 675) from the longitudinal Finnish Diabetic Nephropathy Study (FinnDiane) was used. CKD and PDR were defined as estimated glomerular filtration rate <45 mL/min/1.73m2 (CKD stage 3b) and accorDing to the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol, respectively. CVDwas based on questionnaires and/or hospital discharge registers. Associations of CVD status with CKD and PDR were analyzed by multivariable logistic regression. RESULTS CVD prevalence in the Medalists with CKD and without PDR (+CKD/2PDR) (n = 30) and CVD prevalence in the 2CKD/+PDR group (n = 339) were half the prevalence in the +CKD/+PDR group (n = 66) (34.5% and 42.8%vs. 68.2%, P = 0.002). PDR statuswas independently associated with CVD (odds ratio 0.21 [95% CI 0.08-0.58], P = 0.003) in patients with CKD. Among the Finnish cohort, a trend toward a lower prevalence of CVD in the +CKD/2PDR group (n = 21) compared with the +CKD/+PDR group (n=170) (19.1% vs. 37.1%, P = 0.10) was also observed. CONCLUSIONS Absence of PDR in people with type 1 diabetes and CKD was associated with a decreased prevalence of CVD, suggesting that common protective factors for PDR and CVD may exist.

UR - https://www.scopus.com/pages/publications/85044537927

UR - https://www.scopus.com/pages/publications/85044537927#tab=citedBy

U2 - 10.2337/dc17-2250

DO - 10.2337/dc17-2250

M3 - Article

C2 - 29386250

SN - 0149-5992

VL - 41

SP - 815

EP - 822

JO - Diabetes care

JF - Diabetes care

IS - 4

ER -