<b>Objective:</b>
We hypothesized that there is heterogeneity in long-term patterns of glycemic
control with respect to cardiovascular disease (CVD) development in type 1
diabetes and that risk factors for CVD differ by glycemic control pattern. Thus,
we estimated associations between data-derived latent HbA1c trajectories and
30-year CVD risk in the Pittsburgh Epidemiology of Diabetes Complications (EDC)
study of childhood-onset (<17 years old) type 1 diabetes.<b> </b>
<p><b>Research Design and
Methods: </b>Participants (n=536 with ≥2 HbA1c
measurements [median 6] and CVD-free at baseline; mean age 27 and diabetes
duration 18 years) were followed from 1986-88 to 2016-18 to ascertain CVD
incidence (CVD death, myocardial infarction, stroke, coronary revascularization
or blockage ≥50%, ischemic ECG, or angina). Latent HbA1c trajectories and their
association with time-to-CVD incidence were simultaneously assessed using Joint
Latent Class Mixed Models.</p>
<p><b>Results:</b>
Two HbA1c trajectories with respect to differential CVD risk were identified:
Low (HbA1c ~8% [64 mmol/mol] and improving over follow-up, 76% of cohort) and
High (HbA1c ~10% [86 mmol/mol] and stable, 24%). Overall, 30-year CVD incidence was 47.4%
(n=253); MACE incidence 31.0% (n=176). High HbA1c was associated with 3-fold increased
CVD risk versus Low HbA1c. Both groups had similar
age and diabetes duration. Non-HDLc and estimated glomerular filtration rate were
associated with CVD risk only in Low HbA1c; albumin excretion rate was
associated with CVD risk only in High HbA1c.<b> </b></p>
<p><b>Conclusions: </b>These
risk factor differences suggest that pathways to CVD may differ by glycemic
control, potentially resulting in important implications for prognosis in type
1 diabetes.</p>
30-Year Cardiovascular Disease in Type 1 Diabetes: Risk and Risk Factors Differ by Long-Term Patterns of Glycemic Control