Progression of Coronary Artery Calcification in Type 1 Diabetes
The importance of glycemic control
- Janet K. Snell-Bergeon, MPH1,
- John E. Hokanson, PHD, MPH1,
- Lisa Jensen, RN2,
- Todd MacKenzie, PHD3,
- Gregory Kinney, MPH1,
- Dana Dabelea, MD, PHD1,
- Robert H. Eckel, MD2,
- James Ehrlich, MD4,
- Satish Garg, MD5 and
- Marian Rewers, MD, PHD, MPH15
- 1Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado
- 2Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado
- 3Dartmouth University, Hanover, New Hampshire
- 4Colorado Heart Imaging Center, Denver, Colorado
- 5Barbara Davis Center for Childhood Diabetes, Denver, Colorado
- Address correspondence and reprint requests to Janet K. Snell-Bergeon, MPH, Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, 4200 East 9th Ave., Campus Box C245, Denver, CO 80262. E-mail: janet.snell-bergeon{at}uchsc.edu
Abstract
OBJECTIVE—Coronary artery disease (CAD) occurs earlier in life and is more often fatal in people with type 1 diabetes. This excess risk seems to be higher than in those with type 2 diabetes and is poorly explained by conventional risk factors. The role of glycemic control is controversial and has not been previously addressed in a prospective manner using a reliable marker for subclinical CAD, such as coronary artery calcification (CAC), measured by electron beam computed tomography (EBCT).
RESEARCH DESIGN AND METHODS—We measured CAC twice during an interval of 2.7 years in 109 men and women with type 1 diabetes (aged 22–50 years). Progression of CAC was found in 21 patients, based on change in the square root-transformed volume score.
RESULTS—In multiple logistic regression, CAC progression was associated with baseline hyperglycemia (odds ratio [OR] 7.11, 95% CI 1.38–36.6, P = 0.02), adjusted for the presence of CAC at baseline (P = 0.01), duration of diabetes (P = 0.02), sex (P = 0.09), and age (P = 0.27). There was also a significant interactive effect of higher insulin dose and higher BMI (P = 0.03).
CONCLUSIONS—In conclusion, in this young cohort with type 1 diabetes, suboptimal glycemic control (HbA1c >7.5%) was a strong risk factor for progression of CAC. Insulin resistance may also play a role.
- CAC, coronary artery calcification
- CAD, coronary artery disease
- EBCT, electron beam- computed tomography
- EDC, Epidemiology of Diabetes Complications Study
- SRV, square root-transformed volume
Footnotes
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J.E. is an employee of Colorado Heart Imaging; is a shareholder of Colorado Heart Imaging, HeartScan of Indiana, and HeartCheck Washington DC; and has given lectures on behalf of General Electric/Imatron.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted June 18, 2003.
- Received December 31, 2002.
- DIABETES CARE
