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

Eva Aguilera; Enric Serra-Planas; M. Luisa Granada; Núria Alonso; Silvia Pellitero; Eduarda Pizarro; Jordi Lluís Reverter; Isabel Salinas; Berta Soldevila; Dídac Mauricio; Manel Puig-Domingo

doi:10.2337/dc13-1453

Cardiovascular and Metabolic Risk

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

Eva Aguilera¹ ⇑,
Enric Serra-Planas¹,
M. Luisa Granada²,
Núria Alonso¹,
Silvia Pellitero¹,
Eduarda Pizarro³,
Jordi Lluís Reverter¹,
Isabel Salinas¹,
Berta Soldevila¹,
Dídac Mauricio¹ and
Manel Puig-Domingo¹

¹Endocrinology and Nutrition Unit, Department of Medicine, Institute of Research and Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
²Biochemical Unit, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
³Endocrinology and Nutrition Unit, Hospital de Mataró, Mataró, Barcelona, Spain

Corresponding author: Eva Aguilera, aguilerahurtado{at}yahoo.es.

Diabetes Care 2014 Mar; 37(3): 814-820. https://doi.org/10.2337/dc13-1453

This article has a correction. Please see:

Low Prevalence of Subclinical Atherosclerosis in Asymptomatic Patients With Type 1 Diabetes in a European Mediterranean Population. Diabetes Care 2014;37:814–820 - December 01, 2014

Abstract

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; HbA_1c 8.1 ± 2.3%; 52% nonsmokers; 26% retinopathy; 9% microalbuminuria) and 50 nondiabetic control subjects age and sex matched were studied. Carotid ultrasonography to determine common carotid artery intima-media thickness (c-IMT) and the presence of atheroma plaques and cardiac computed tomography for calcium analysis and quantification (coronary artery calcium score [CACS]) were performed.

RESULTS Most patients with type 1 diabetes and control subjects displayed a CACS of 0 (82 vs. 92%). Patients with type 1 diabetes with CACS ≥1 were older and had higher HbA_1c (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) and longer evolution of diabetes (25.4 ± 9.2 vs. 19.3 ± 7.4 years, P < 0.005) and mean c-IMT (0.67 ± 0.18 vs. 0.53 ± 0.11 mm, P < 0.001) compared with patients with CACS of 0. Smoking (P < 0.02), nephropathy (P < 0.05), retinopathy (P < 0.05), and male sex (P < 0.03) were significantly and positively associated with CACS ≥1. Mean c-IMT was significantly higher in patients with type 1 diabetes (0.55 ± 0.14 vs. 0.48 ± 0.14 mm, P < 0.01), and 11% of them presented atheroma plaques (8% of control subjects). Multivariant logistic regression analysis showed that c-IMT was related to CACS (β = 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 may be useful for screening in the subset of patients with cardiovascular risk factors and long disease evolution.

Footnotes

This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc13-1453/-/DC1.

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

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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