Delineation of Prevalence and Risk Factors for Early Coronary Artery Disease by Electron Beam Computed Tomography in Young Adults With Type 1 Diabetes

  1. Harold S. Starkman, MD1,
  2. Gregory Cable, PHD2,
  3. Virginia Hala, RN3,
  4. Harvey Hecht, MD4 and
  5. Christine M. Donnelly, MD5
  1. 1BD Diabetes Center for Children and Adolescents, Atlantic Health System, Morristown, New Jersey
  2. 2Atlantic Health System, Florham Park, New Jersey
  3. 3Department of Pediatrics, Morristown Memorial Hospital, Atlantic Health System, Morristown, New Jersey
  4. 4Princeton Longevity Center, Princeton, New Jersey
  5. 5Children’s Heart Center, Atlantic Health System, Morristown, New Jersey

    Abstract

    OBJECTIVE—Type 1 diabetes increases the risk for coronary artery disease (CAD), but limited information is available regarding the early natural history of this process. Electron beam tomography (EBT) can measure coronary artery calcification (CAC), an early marker for CAD. This study was designed to assess the prevalence and risk factors for CAC in young adults with established type 1 diabetes.

    RESEARCH DESIGN AND METHODS—A total of 101 subjects aged 17–28 years with type 1 diabetes of over 5 years’ duration and no history of heart disease underwent cardiac EBT with calcium scoring. Medical histories were obtained and physical examinations were conducted to document the presence of cardiac risk factors as well as evidence of microvasculopathy and diabetic arthropathy. Laboratory evaluation included measurement of fasting lipoproteins, homocysteine concentration, lipoprotein(a) [Lp(a)], urinary microalbumin, and HbA1c. Contingency table analysis was used to assess bivariate relationships. Logistic regression was employed to construct a parsimonious model of independent risk factors.

    RESULTS—Eleven subjects (10.9%) had CAC. Smokers were nearly five times more likely than nonsmokers to have CAC (P = 0.03). In addition, each 0.36-mm/l increment of Lp(a) was associated with a 10% increased risk for CAC (P = 0.05) after controlling for potentially confounding factors. There was no association of other CAD or diabetes risk factors studied with CAC.

    CONCLUSIONS—The prevalence of early CAD as evidenced by CAC in young adults with type 1 diabetes is significant. Smoking and Lp(a) levels independently predict the presence of CAC. Additional study is necessary to delineate the natural history of CAC and the role of risk factor modification to prevent progression of CAD in this high-risk population.

    Footnotes

    • Address correspondence and reprint requests to Harold Starkman, MD, BD Diabetes Center for Children and Adolescents, Morristown Memorial Hospital, Atlantic Health System, 100 Madison Ave., Morristown, NJ 07962-1953. E-mail: harold.starkman{at}ahsys.org.

      Received for publication 26 June 2002 and accepted in revised form 28 September 2002.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

      See Point-Counterpoint, p. 541–544.

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