Low Prevalence of Sublinical Atherosclerosis in Asymptomatic Patients With Type 1 Diabetes Mellitus in a European Mediterranean Population

  1. Manel Puig-Domingo1
  1. 1Endocrinology and Nutrition Unit, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
  2. 2Biochemical Unit, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
  3. 3Endocrinology and Nutrition Unit, Hospital de Mataró, Mataró, Barcelona, Spain
  1. Corresponding Author: E. Aguilera, Email: aguilerahurtado{at}yahoo.es

Abstract

Screening of cardiovascular disease in asymptomatic type 1 diabetes (type 1 diabetes) is a controversial issue.

Objective To evaluate the presence of early carotid and coronary atherosclerosis in asymptomatic patients with type 1 diabetes with no history of ischemic heart disease.

Research Design and Methods One hundred and fifty patients with type 1 diabetes (58% males; 38.6±8.1 years, 20.4±8.1 years of evolution; HbA1c: 8.1±2.3%; 52% non-smokers; 26% retinopathy; 9% microalbuminuria) and 50 non-diabetic controls age and sex matched were studied. Carotid ultrasonography to determine cIMT and the presence of atheroma plaques, and cardiac CT for calcium analysis and quantification (CACS) were performed.

Results Most patients with type 1 diabetes and controls displayed a CACS of 0 (82% vs 92%). Patients with type 1 diabetes with CACS ≥1 were older and had higher HbA1c (44.5±5.1 vs. 36.7±8.1 years p<0.001 and 8.5±1.1 vs. 7.8±1.0% p<0.003, respectively), longer evolution of diabetes (25.4±9.2 vs. 19.3±7.4 years p<0.005) and mean cIMT (0.67±0.18mm. vs. 0.53±0.11mm. p<0.001) compared to patients with CACS of 0. Smoking (p<0.02), nephropathy (p<0.05), retinopathy (p<0.05) and male gender (p<0.03) were significantly and positively associated to CACS ≥1. Mean cIMT was significantly higher in patients with type 1 diabetes (0.55±0.14 vs. 0.48±0.14mm p<0.01) and 11% of them presented atheroma plaques (8% controls). Multivariant logistic regression analysis showed that c-IMT was related to CACS (beta=6.87, p<0.001).

Conclusions A small percentage of patients with type 1 diabetes showed data suggestive of subclinical atherosclerosis. Universal screening of coronary disease in this population is not justified. Carotid ultrasonography maybe useful for screening in the subset of patients with cardiovascular risk factors and long disease evolution.

  • Received June 19, 2013.
  • Accepted October 11, 2013.

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