428-P: Heart Failure (HF) and Its Risk Factors in Long-Duration Type 1 Diabetes (T1D)

Objective The aim of this study was to determine the incidence of cardiovascular disease (CVD) and mortality as well as their risk factors in type 1 diabetes (T1D) with more than 50-years duration. Methods From 5,396 individuals included in the Finnish Diabetic Nephropathy Study, 729 diagnosed in 1967 or earlier survived with T1D for more than 50 years. In this FinnDiane 50-year cohort, cumulative incidence of CVD events was assessed from the diagnosis of diabetes, and the excess CVD risk, compared to matched 12,710 individuals without diabetes, was calculated by Fine and Gray’s method. In addition, at the baseline visit (median duration of diabetes of 39 years) risk factors for different types of CVD (both non-fatal and fatal) and mortality were analyzed and cause-specific hazard ratios were estimated during a median follow-up of 16.6 years from the baseline visit. Results In individuals with diabetes duration of more than 50 years, the 60-year cumulative incidence of CVD from the diagnosis of diabetes was 64.3% (62.5-66.0). Compared to individuals without diabetes, the standardized incidence ratio for CVD was 7.4 (6.5-8.3) and was in persons with normoalbuminuria 4.9 (4.0-5.9). Mean HbA1c and HbA1c variability, dyslipidemia, BMI, kidney disease, age and diabetes duration were the variables associated with incident CVD. In particular, HbA1c was associated with peripheral artery disease (PAD). Standardized mortality ratio compared with the Finnish background population was 3.2 (2.8-3.7). The factors, associated with mortality were diabetes duration, increased HbA1c variability, inflammation, insulin resistance, kidney disease and PAD. Conclusions Individuals with T1D of very long duration are at a high risk of CVD. In addition, throughout the lifespan, optimal glycemic control remains central to CVD and excess mortality prevention.

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224-OR: Cardiac Imaging and Metabolomics Studies Suggest Shared and Distinct Risk Factors for Atherosclerosis and Cardiomyopathy in Renoprotected, Long-Duration Type 1 Diabetes

Diabetes ◽

10.2337/db21-224-or ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 224-OR

Author(s):

MARC GREGORY YU ◽

HETAL SHAH ◽

EMILY WOLFSON ◽

ATIF ADAM ◽

JOHN GAUTHIER ◽

...

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Cardiac Imaging ◽

Long Duration

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Investigation of early signs of systolic and diastolic dysfunction among persons with type 1 diabetes

Open Heart ◽

10.1136/openhrt-2019-001020 ◽

2019 ◽

Vol 6 (2) ◽

pp. e001020

Author(s):

Daniel Vestberg ◽

Magnus Carl Johansson ◽

Anette Letho ◽

Aldina Pivodic ◽

Sara Hallström ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Type 1 Diabetes ◽

Diastolic Dysfunction ◽

Systolic Dysfunction ◽

Significant Risk ◽

Significant Risk Factor ◽

Early Signs ◽

Study Population

BackgroundPersons with type 1 diabetes have a higher risk to develop heart failure than the general population, and the mechanism behind the increased risk is unclear. In epidemiological studies with hospitalisation for heart failure as endpoint HbA1c, body mass index and decreased kidney function are significant risk factors, but it is unclear how these risk factors influence the development of heart failure.MethodsIn this study, we investigated early signs of systolic and diastolic dysfunction with transthoracic echocardiography. Statistical analysis on correlation of risk factors and early signs of diastolic and systolic dysfunction was made.ResultsIn this study population of 287 persons with type 1 diabetes, 160 were men and 127 were women with a mean age of 53.8 (SD 11.6) years and a mean diabetes duration of 36.2 (SD 13.5) years. There were 23 (8.2%) persons who fulfilled the definition of systolic dysfunction (ejection fraction <50% or regional wall motion abnormalities) and 24 persons (9%) the definition for diastolic dysfunction. When comparing the groups with either systolic or diastolic dysfunction to the rest of the population, the only significant risk factor was age in both groups and previous myocardial infarction in the systolic group.ConclusionIn our study population with type 1 diabetes, we found signs of diastolic dysfunction in 9% and systolic dysfunction in 8.2%. Compared with published data from the general population, this rate is somewhat higher in a younger population. Only age was a significant risk factor in the study.

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Presence and Determinants of Cardiovascular Disease and Mortality in Individuals With Type 1 Diabetes of Long Duration: The FinnDiane 50 Years of Diabetes Study

10.2337/figshare.14626908 ◽

2021 ◽

Author(s):

Valma Harjutsalo ◽

Drazenka Pongrac Barlovic ◽

Daniel Gordin ◽

Carol Forsblom ◽

George King ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Type 1 Diabetes ◽

Kidney Disease ◽

Cumulative Incidence ◽

Diabetes Duration ◽

Baseline Visit ◽

Background Population ◽

Long Duration

Objective The aim of this study was to determine the incidence of cardiovascular disease (CVD) and mortality as well as their risk factors in type 1 diabetes (T1D) with more than 50-years duration. Methods From 5,396 individuals included in the Finnish Diabetic Nephropathy Study, 729 diagnosed in 1967 or earlier survived with T1D for more than 50 years. In this FinnDiane 50-year cohort, cumulative incidence of CVD events was assessed from the diagnosis of diabetes, and the excess CVD risk, compared to matched 12,710 individuals without diabetes, was calculated by Fine and Gray’s method. In addition, at the baseline visit (median duration of diabetes of 39 years) risk factors for different types of CVD (both non-fatal and fatal) and mortality were analyzed and cause-specific hazard ratios were estimated during a median follow-up of 16.6 years from the baseline visit. Results In individuals with diabetes duration of more than 50 years, the 60-year cumulative incidence of CVD from the diagnosis of diabetes was 64.3% (62.5-66.0). Compared to individuals without diabetes, the standardized incidence ratio for CVD was 7.4 (6.5-8.3) and was in persons with normoalbuminuria 4.9 (4.0-5.9). Mean HbA1c and HbA1c variability, dyslipidemia, BMI, kidney disease, age and diabetes duration were the variables associated with incident CVD. In particular, HbA1c was associated with peripheral artery disease (PAD). Standardized mortality ratio compared with the Finnish background population was 3.2 (2.8-3.7). The factors, associated with mortality were diabetes duration, increased HbA1c variability, inflammation, insulin resistance, kidney disease and PAD. Conclusions Individuals with T1D of very long duration are at a high risk of CVD. In addition, throughout the lifespan, optimal glycemic control remains central to CVD and excess mortality prevention.

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