PT  - JOURNAL ARTICLE
AU  - Gordin, Daniel
AU  - Harjutsalo, Valma
AU  - Tinsley, Liane
AU  - Fickweiler, Ward
AU  - Sun, Jennifer K.
AU  - Forsblom, Carol
AU  - Amenta, Peter S.
AU  - Pober, David
AU  - D’Eon, Stephanie
AU  - Khatri, Maya
AU  - Stillman, Isaac E.
AU  - Groop, Per-Henrik
AU  - Keenan, Hillary A.
AU  - King, George L.
TI  - Differential Association of Microvascular Attributions With Cardiovascular Disease in Patients With Long Duration of Type 1 Diabetes
AID  - 10.2337/dc17-2250
DP  - 2018 Apr 01
TA  - Diabetes Care
PG  - 815--822
VI  - 41
IP  - 4
4099  - http://care.diabetesjournals.org/content/41/4/815.short
4100  - http://care.diabetesjournals.org/content/41/4/815.full
SO  - Diabetes Care2018 Apr 01; 41
AB  - OBJECTIVE Independent association of chronic kidney disease (CKD) and proliferative diabetic retinopathy (PDR) with cardiovascular disease (CVD) has not been established. In the Joslin 50-Year Medalist study, characterizing individuals with type 1 diabetes for 50 years or more, we examined the associations of CKD and PDR with CVD, which was validated by another cohort with type 1 diabetes from Finland.RESEARCH DESIGN AND METHODS This cross-sectional study characterized U.S. residents (n = 762) with type 1 diabetes of 50 years or longer (Medalists) at a single site by questionnaire, clinical, ophthalmic, and laboratory studies. A replication cohort (n = 675) from the longitudinal Finnish Diabetic Nephropathy Study (FinnDiane) was used. CKD and PDR were defined as estimated glomerular filtration rate <45 mL/min/1.73 m2 (CKD stage 3b) and according to the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol, respectively. CVD was based on questionnaires and/or hospital discharge registers. Associations of CVD status with CKD and PDR were analyzed by multivariable logistic regression.RESULTS CVD prevalence in the Medalists with CKD and without PDR (+CKD/−PDR) (n = 30) and CVD prevalence in the −CKD/+PDR group (n = 339) were half the prevalence in the +CKD/+PDR group (n = 66) (34.5% and 42.8% vs. 68.2%, P = 0.002). PDR status was independently associated with CVD (odds ratio 0.21 [95% CI 0.08–0.58], P = 0.003) in patients with CKD. Among the Finnish cohort, a trend toward a lower prevalence of CVD in the +CKD/−PDR group (n = 21) compared with the +CKD/+PDR group (n = 170) (19.1% vs. 37.1%, P = 0.10) was also observed.CONCLUSIONS Absence of PDR in people with type 1 diabetes and CKD was associated with a decreased prevalence of CVD, suggesting that common protective factors for PDR and CVD may exist.