20 years’ type 1 diabetes duration marks upshift in CVD risk
medwireNews: Type 1 diabetes duration of at least 20 years is linked to increased cardiovascular disease (CVD) risk, with an increasing association seen after this time, Australian study results suggest.
As reported in Cardiovascular Diabetology, cardiovascular risk factors were “highly prevalent” among 1169 adults with type 1 diabetes included in the 2015 Australian National Diabetes Audit. Almost 90% of patients had dyslipidemia, while 81% had glycated hemoglobin levels above 7%, 56% were overweight or obese, 39% were ever-smokers, and 22% had hypertension. The average diabetes duration was 19.2 years.
Sophia Zoungas (Monash University, Melbourne, Victoria) and study co-authors found that patients’ risk for CVD – including stroke, myocardial infarction, coronary artery bypass surgery/angioplasty, and peripheral vascular disease – was “low and static” during the first 20 years of having type 1 diabetes.
However, patients who had diabetes for at least 20 years had a 5% higher risk for CVD than those with shorter disease duration after adjustment for factors including age and sex, and after this cutoff there was a positive linear relationship between diabetes duration and CVD risk.
Older age, current smoking, and prescription of treatment for hypertension were also significantly associated with increased CVD risk on multivariable analysis (adjusted odds ratios [ORs]= 1.06, 2.40, and 2.44, respectively), whereas higher levels of high-density lipoprotein cholesterol and increasing diastolic blood pressure were associated with lower risk for CVD (adjusted ORs=0.43 and 0.96, respectively).
When all of these variables were combined into a model, the researchers were able to correctly distinguish between patients who did and did not develop CVD on 88% of occasions.
These findings indicate that “a group of traditional cardiovascular risk factors […] and diabetes specific risk factors […] provide good discriminatory ability for the presence of CVD,” write Zoungas and colleagues.
They note that of these factors, diabetes duration of at least 20 years was associated with the highest estimated population-attributable CVD risk, at 6.5%, followed by antihypertensive therapy and smoking, at 5.1% and 3.9%, respectively.
“Given the substantial population risk of CVD attributable to long diabetes duration, the impact of new cardiovascular risk stratification tools and interventions to manage risk factors before and after 20 years duration will need to be further assessed by prospective studies,” concludes the team.
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