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Risk Factors for Coronary Heart Disease in Type 1 Diabetic Patients in Europe

The EURODIAB Prospective Complications Study

¹ Department of Epidemiology and Public-Health, Royal Free and University College London Medical School, London, U.K
² International Centre for Circulatory Health and Department of Epidemiology and Public-Health, Imperial College London, London, U.K
³ Diabetes Research Institute, Heinrich-Heine University, Dusseldorf, Germany
⁴ Cork Regional Hospital, Cork, Ireland
⁵ Dipartimento di Medicina Interna e Scienze, Endocrine e Metaboliche, Perugia, Italy
⁶ Centre Hospitalier, Luxembourg, Luxemburg
⁷ General Hospital of Thessaloniki, Thessaloniki, Greece

Address correspondence and reprint requests to Sabita S. Soedamah-Muthu, EURODIAB Department of Epidemiology and Public-Health Royal Free and University College London Medical School 1-19 Torrington Place, London, WC1E 6BT U.K.. E-mail: sabita{at}public-health.ucl.ac.uk

OBJECTIVE—The goal of the study was to examine risk factors in the prediction of coronary heart disease (CHD) and differences in men and women in the EURODIAB Prospective Complications Study.

RESEARCH DESIGN AND METHODS—Baseline risk factors and CHD at follow-up were assessed in 2,329 type 1 diabetic patients without prior CHD. CHD was defined as physician-diagnosed myocardial infarction, angina pectoris, coronary artery bypass graft surgery, and/or Minnesota-coded ischemic electrocardiograms or fatal CHD.

RESULTS—There were 151 patients who developed CHD, and the 7-year incidence rate was 8.0 (per 1,000 person-years) in men and 10.2 in women. After adjustment for age and/or duration of diabetes, the following risk factors were related to CHD in men: age, GHb, waist-to-hip ratio (WHR), HDL cholesterol, smoking, albumin excretion rate (AER), and autonomic neuropathy. The following risk factors were related to CHD in women: age, systolic blood pressure (BP), fasting triglycerides, AER, and retinopathy. Multivariate standardized Cox proportional hazards models showed that age (hazard ratio 1.5), AER (1.3 in men and 1.6 in women), WHR (1.3 in men), smoking (1.5 in men), fasting triglycerides (1.3 in women) or HDL cholesterol (0.74 in women), and systolic BP (1.3 in women) were predictors of CHD.

CONCLUSIONS—This study supports the evidence for a strong predictive role of baseline albuminuria in the pathogenesis of CHD in type 1 diabetes. Furthermore, sex-specific risk factors such as systolic BP, fasting triglycerides (or HDL cholesterol), and WHR were found to be important in the development of CHD.

Abbreviations: AER, albumin excretion rate • BP, blood pressure • CHD, coronary heart disease • ECG, electrocardiogram • EDC, epidemiology of diabetes complications • FTG, fasting triglycerides • MI, myocardial infarction • PCS, Prospective Complications Study • WHR, waist-to-hip ratio

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