Arterial Stiffness Predicts Mortality in Individuals With Type 1 Diabetes

Cardiovascular and Metabolic Risk

¹Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
²Abdominal Center Nephrology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
³Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
⁴National Institute for Health and Welfare, Helsinki, Finland
⁵Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
⁶Joslin Diabetes Center, Harvard Medical School, Boston, MA

Diabetes Care 2020 Sep; 43(9): 2266-2271. https://doi.org/10.2337/dc20-0078

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Figure 1
Kaplan-Meier survival curves with log-rank tests for all-cause mortality (N = 67) by AIx tertiles.

Table 1

Baseline characteristics according to survival status

	Alive	Dead	P value
N	839	67
Male sex	381 (45.4)	35 (52.2)	0.280
Age (years)	42.5 ± 12.0	52.9 ± 11.4	<0.001
Diabetes duration (years)	26.5 ± 12.6	37.4 ± 13.1	<0.001
Age at onset (years)	14.0 (9.8–21.9)	13.2 (8.6–21.3)	0.533
Height (cm)	171.8 ± 9.6	169.5 ± 10.2	0.059
BMI (kg/m²)	25.1 (22.9–27.6)	23.9 (21.5–26.3)	0.011
SBP (mmHg)	134 (123–146)	151 (135–166)	<0.001
DBP (mmHg)	76 ± 9	77 ± 10	0.632
PP (mmHg)	57 (48–69)	76 (56–93)	<0.001
Antihypertensive medication (%)	368 (44.1)	53 (79.1)	<0.001
RAAS blockers (%)	321 (38.4)	38 (56.7)	0.003
HbA_1c (%; mmol/mol)	7.9 (7.2–8.7); 63 (55–72)	8.3 (7.7–9.3); 67 (61–78)	0.005
Total cholesterol (mmol/L)	4.5 (4.0–5.1)	4.6 (4.0–5.3)	0.619
HDL cholesterol (mmol/L)	1.53 (1.29–1.86)	1.57 (1.41–2.03)	0.162
LDL cholesterol (mmol/L)	2.5 (2.0–3.0)	2.4 (1.9–3.0)	0.337
Triglycerides (mmol/L)	0.92 (0.70–1.31)	1.10 (0.84–1.55)	0.003
Statin therapy (%)	213 (25.5)	30 (45.5)	<0.001
eGFR (mL/min/1.73 m²)	103 (87–115)	64 (39–92)	<0.001
Ever smoked (%)	354 (43.6)	35 (53.8)	0.111
Previous cardiovascular event (%)^*	66 (7.9)	32 (48.5)	<0.001
AIx (%)	19 (9–27)	28 (21–33)	<0.001
SEVR (%)	142 (123–164)	116 (102–138)	<0.001
CSBP (mmHg)	119 (109–131)	138 (121–150)	<0.001
CDBP (mmHg)	77 ± 9	78 ± 10	0.661
CMAP (mmHg)	91 (85–98)	96 (91–105)	<0.001
CPP (mmHg)	41 (34–52)	61 (44–80)	<0.001
ED (ms)	326 ± 22	329 ± 27	0.432
CESP (mmHg)	105 (96–116)	115 (106–125)	<0.001

Data are N (%), mean ± SD, or median (interquartile range) unless otherwise indicated.
ED, ejection duration; RAAS, renin-angiotensin-aldosterone system.
↵* Previous cardiovascular event defined as myocardial infarction, coronary revascularization, stroke, lower-extremity revascularization, or nontraumatic amputation.

Table 2

Central hemodynamic variables in association with all-cause mortality in multivariable Cox regression models

Data are sHR (95% CI) and P values. Model 1: unadjusted. Model 2: adjustment for age and sex. Model 3: adjustment for age, sex, BMI, and HbA_1c. Model 4: adjustment for age, sex, BMI, HbA_1c, eGFR, and previous cardiovascular event (myocardial infarction, coronary revascularization, stroke, lower-extremity revascularization, or nontraumatic amputation).

Table 3

AIx in association with cardiovascular and diabetes-related mortality in multivariable Cox regression models

Cardiovascular/diabetes-related mortality
Yes (N = 53)		No (N = 14)
Added variable	AIx sHR (95% CI)	Added variable	AIx sHR (95% CI)
	3.469 (2.315–5.199); P < 0.001		1.426 (0.779–2.609); P = 0.250
+ Male sex	4.402 (2.896–6.691); P < 0.001	+ Male sex	1.561 (0.815–2.991); P = 0.179
+ BMI	4.338 (2.843–6.619); P < 0.001
+ eGFR	2.794 (1.767–4.419); P < 0.001
+ CVD event	2.743 (1.674–4.493); P < 0.001
+ Height	2.296 (1.378–3.825); P = 0.001