Type A Behavior and Risk of All-Cause Mortality, CAD, and CAD-Related Mortality in a Type 1 Diabetic Population
22 years of follow-up in the Pittsburgh Epidemiology of Diabetes Complications Study
- Catherine E. Fickley, MPH, CPH1,
- Cathy E. Lloyd, PHD2,
- Tina Costacou, PHD1,
- Rachel G. Miller, MS1 and
- Trevor J. Orchard, MD, MMedSci, FAHA1⇑
- 1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- 2Health and Social Care Programme, The Open University, Milton Keynes, U.K.
- Corresponding author: Trevor Orchard, .
OBJECTIVE To determine whether type A behavior predicts all-cause mortality and incident coronary artery disease (CAD) in a type 1 diabetic population.
RESEARCH DESIGN AND METHODS Follow-up data (22 years) from the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset type 1 diabetes were analyzed for the 506 participants who completed the Bortner Rating Scale (measuring type A behavior) and Beck Depression Inventory (BDI) at baseline (1986–1988). CAD comprised myocardial infarction as determined by hospital records/Q waves on electrocardiogram (ECG), CAD death (determined by a mortality classification committee), angiographic stenosis, ischemic ECG, and angina.
RESULTS There were 128 deaths (25.3%) during follow-up. Univariate analysis showed an inverse relationship between Bortner scores and all-cause mortality (P = 0.01), which remained significant after allowing for age, sex, duration, HbA1c, education, smoking, BMI, and physical activity (P = 0.03). However, the addition of BDI scores attenuated the relationship (P = 0.11) with a significant interaction (P = 0.03) such that any protective effect against mortality was limited among individuals with lower BDI scores (bottom three quintiles) (P = 0.07), whereas no effect was seen in those with higher BDI (P = 0.97). Bortner scores showed only a borderline association with incident CAD (P = 0.09).
CONCLUSIONS Those with higher type A behavior have lower all-cause mortality in our type 1 diabetic population, an effect that interacts with depressive symptomatology such that it is only operative in those with low BDI scores. Further research should focus on understanding this interaction.
- Received January 31, 2013.
- Accepted April 29, 2013.
- © 2013 by the American Diabetes Association.
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