664-P: What Do Youth with Type 1 Diabetes (T1DM) and Caregivers Know about Cardiovascular Disease (CVD) Risk and Reduction?

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 664-P
Author(s):  
JODI KRALL ◽  
KRISTINE RUPPERT ◽  
ANA M. DIAZ ◽  
JESSICA FINNEY ◽  
LINDA M. SIMINERIO ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Cvd Risk

scholarly journals 30-Year Cardiovascular Disease in Type 1 Diabetes: Risk and Risk Factors Differ by Long-Term Patterns of Glycemic Control

2021 ◽  
Author(s):  
Rachel G. Miller ◽  
Trevor J. Orchard ◽  
Tina Costacou
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Latent Class ◽  
Diabetes Duration ◽  
Cvd Risk ◽  
High Hba1c

<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>

scholarly journals Risk Factors for Cardiovascular Disease (CVD) in Adults with Type 1 Diabetes: Findings from Prospective Real-life T1D Exchange Registry

2020 ◽  
Vol 105 (5) ◽  
pp. e2032-e2038 ◽  
Author(s):  
Viral N Shah ◽  
Ryan Bailey ◽  
Mengdi Wu ◽  
Nicole C Foster ◽  
Rodica Pop-Busui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Diabetic Nephropathy ◽  
The United States ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
The Impact

Abstract Context Cardiovascular disease (CVD) is a major cause of mortality in adults with type 1 diabetes. Objective We prospectively evaluated CVD risk factors in a large, contemporary cohort of adults with type 1 diabetes living in the United States. Design Observational study of CVD and CVD risk factors over a median of 5.3 years. Setting The T1D Exchange clinic network. Patients Adults (age ≥ 18 years) with type 1 diabetes and without known CVD diagnosed before or at enrollment. Main Outcome Measure Associations between CVD risk factors and incident CVD were assessed by multivariable logistic regression. Results The study included 8,727 participants (53% female, 88% non-Hispanic white, median age 33 years [interquartile ratio {IQR} = 21, 48], type 1 diabetes duration 16 years [IQR = 9, 26]). At enrollment, median HbA1c was 7.6% (66 mmol/mol) (IQR = 6.9 [52], 8.6 [70]), 33% used a statin, and 37% used blood pressure medication. Over a mean follow-up of 4.6 years, 325 (3.7%) participants developed incident CVD. Ischemic heart disease was the most common CVD event. Increasing age, body mass index, HbA1c, presence of hypertension and dyslipidemia, increasing duration of diabetes, and diabetic nephropathy were associated with increased risk for CVD. There were no significant gender differences in CVD risk. Conclusion HbA1c, hypertension, dyslipidemia and diabetic nephropathy are important risk factors for CVD in adults with type 1 diabetes. A longer follow-up is likely required to assess the impact of other traditional CVD risk factors on incident CVD in the current era.

scholarly journals Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes

2021 ◽  
Vol 22 (19) ◽  
pp. 10192
Author(s):  
Darja Smigoc Schweiger ◽  
Tadej Battelino ◽  
Urh Groselj
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Risk Profile ◽  
Cvd Risk Factors ◽  
Cvd Risk

Cardiovascular disease (CVD) is the primary cause of higher and earlier morbidity and mortality in people with type 1 diabetes (T1D) compared to people without diabetes. In addition, women with T1D are at an even higher relative risk for CVD than men. However, the underlying pathophysiology is not well understood. Atherosclerotic changes are known to progress early in life among people with T1D, yet it is less clear when excess CVD risk begins in females with T1D. This review explores the prevalence of classical CVD risk factors (such as glycemic control, hypertension, dyslipidemia, obesity, albuminuria, smoking, diet, physical inactivity), as well as of novel biomarkers (such as chronic inflammation), in children and adolescents with T1D with particular regard to sex-related differences in risk profile. We also summarize gaps where further research and clearer clinical guidance are needed to better address this issue. Considering that girls with T1D might have a more adverse CVD risk profile than boys, the early identification of and sex-specific intervention in T1D would have the potential to reduce later CVD morbidity and excess mortality in females with T1D. To conclude, based on an extensive review of the existing literature, we found a clear difference between boys and girls with T1D in the presence of individual CVD risk factors as well as in overall CVD risk profiles; the girls were on the whole more impacted.

scholarly journals The Low-Expression Variant of FABP4 is Associated with Cardiovascular Disease in Type 1 Diabetes

2021 ◽  
Author(s):  
Emma H. Dahlström ◽  
Jani Saksi ◽  
Carol Forsblom ◽  
Nicoline Uglebjerg ◽  
Nina Mars ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Meta Analysis ◽  
Cardiometabolic Health ◽  
Cvd Risk ◽  
Fatty Acid Binding ◽  
Cardiometabolic Disorders ◽  
End Stage ◽  
Low Expression

Fatty-acid binding protein 4 (FABP4) is implicated in the pathogenesis of cardiometabolic disorders. Pharmacological inhibition or genetic deletion of FABP4 improves cardiometabolic health and protects against atherosclerosis in preclinical models. As cardiovascular disease (CVD) is common in type 1 diabetes, we examined the role of FABP4 for the development of complications in type 1 diabetes, focusing on a functional, low-expression, variant (rs77878271) in the promoter of the <i>FABP4</i> gene. For this, we assessed the risk of CVD, stroke, coronary artery disease (CAD), end-stage kidney disease (ESKD), and mortality using Cox proportional-hazard models for the <i>FABP4</i> rs77878271 in 5,077 Finnish individuals with type 1 diabetes. The low-expression G-allele of<b> </b>rs77878271 increased the risk of CVD, independently of confounders. <a>Findings were tested for replication in 852 Danish and 3,678 Finnish individuals with type 1 diabetes. </a>In the meta-analysis, each G-allele increased the risk of stroke by 26% (p=0.04), CAD by 26% (p=0.006), and CVD by 17% (p=0.003). In Mendelian Randomization, a decrease in FABP4 increased CAD 2.4-fold. Hence<b>, </b>in contrast to the general population, the low-expression G-allele of rs77878271 increased CVD risk in type 1 diabetes, suggesting that genetically low FABP4<i> </i>levels may be detrimental in the context of type 1 diabetes.

scholarly journals The Low-Expression Variant of FABP4 is Associated with Cardiovascular Disease in Type 1 Diabetes

2021 ◽  
Author(s):  
Emma H. Dahlström ◽  
Jani Saksi ◽  
Carol Forsblom ◽  
Nicoline Uglebjerg ◽  
Nina Mars ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Meta Analysis ◽  
Cardiometabolic Health ◽  
Cvd Risk ◽  
Fatty Acid Binding ◽  
Cardiometabolic Disorders ◽  
End Stage ◽  
Low Expression

Fatty-acid binding protein 4 (FABP4) is implicated in the pathogenesis of cardiometabolic disorders. Pharmacological inhibition or genetic deletion of FABP4 improves cardiometabolic health and protects against atherosclerosis in preclinical models. As cardiovascular disease (CVD) is common in type 1 diabetes, we examined the role of FABP4 for the development of complications in type 1 diabetes, focusing on a functional, low-expression, variant (rs77878271) in the promoter of the <i>FABP4</i> gene. For this, we assessed the risk of CVD, stroke, coronary artery disease (CAD), end-stage kidney disease (ESKD), and mortality using Cox proportional-hazard models for the <i>FABP4</i> rs77878271 in 5,077 Finnish individuals with type 1 diabetes. The low-expression G-allele of<b> </b>rs77878271 increased the risk of CVD, independently of confounders. <a>Findings were tested for replication in 852 Danish and 3,678 Finnish individuals with type 1 diabetes. </a>In the meta-analysis, each G-allele increased the risk of stroke by 26% (p=0.04), CAD by 26% (p=0.006), and CVD by 17% (p=0.003). In Mendelian Randomization, a decrease in FABP4 increased CAD 2.4-fold. Hence<b>, </b>in contrast to the general population, the low-expression G-allele of rs77878271 increased CVD risk in type 1 diabetes, suggesting that genetically low FABP4<i> </i>levels may be detrimental in the context of type 1 diabetes.

scholarly journals Longitudinal Plasma Kallikrein Levels and their Association with the Risk of Cardiovascular Disease Outcomes in Type 1 Diabetes in DCCT/EDIC

2020 ◽  
Author(s):  
Ada Admin ◽  
Miran A Jaffa ◽  
Ionut Bebu ◽  
Deirdre Luttrell ◽  
Barbara H Braffett ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Major Adverse Cardiovascular Events ◽  
Plasma Kallikrein ◽  
Cvd Risk ◽  
20 Nm ◽  
Adjusted Model

We determined the relationship between plasma kallikrein and cardiovascular disease (CVD) outcomes as well as major adverse cardiovascular events (MACE) in the DCCT/EDIC-cohort of type 1 diabetes (T1D). Plasma kallikrein levels were measured longitudinally in 693 subjects at DCCT baseline (1983-1989), mid-point of DCCT (1988-1991), end of DCCT (1993), and EDIC years 4-6 (1997-1999), 8-10 (2001-2003), and 11-13 (2004-2006). Cox proportional hazards regression models assessed the association between plasma kallikrein levels and the risk of CVD. In unadjusted models, higher plasma kallikrein levels were associated with higher risk of any CVD during DCCT/EDIC (HR=1.16 per 20 nM higher levels of plasma kallikrein; p=0.0177) as well as over the EDIC-only period (HR=1.22; p=0.0024). The association between plasma kallikrein levels and the risk of any CVD remained significant during the EDIC follow-up after adjustment for age and mean HbA1c (HR=1.20; p=0.0082) and in the fully adjusted model for other CVD risk factors (HR=1.17; p=0.0330). For MACE, higher plasma kallikrein levels were associated with higher risk in unadjusted (HR=1.25; p=0.0145), minimally adjusted (HR=1.23; p=0.0417, and fully adjusted (HR=1.27; p=0.0328) models during EDIC-only. These novel findings indicate that plasma kallikrein level associates with the risk of any CVD and MACE in T1D individuals.

scholarly journals Longitudinal Plasma Kallikrein Levels and their Association with the Risk of Cardiovascular Disease Outcomes in Type 1 Diabetes in DCCT/EDIC

2020 ◽  
Author(s):  
Ada Admin ◽  
Miran A Jaffa ◽  
Ionut Bebu ◽  
Deirdre Luttrell ◽  
Barbara H Braffett ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Major Adverse Cardiovascular Events ◽  
Plasma Kallikrein ◽  
Cvd Risk ◽  
20 Nm ◽  
Adjusted Model

We determined the relationship between plasma kallikrein and cardiovascular disease (CVD) outcomes as well as major adverse cardiovascular events (MACE) in the DCCT/EDIC-cohort of type 1 diabetes (T1D). Plasma kallikrein levels were measured longitudinally in 693 subjects at DCCT baseline (1983-1989), mid-point of DCCT (1988-1991), end of DCCT (1993), and EDIC years 4-6 (1997-1999), 8-10 (2001-2003), and 11-13 (2004-2006). Cox proportional hazards regression models assessed the association between plasma kallikrein levels and the risk of CVD. In unadjusted models, higher plasma kallikrein levels were associated with higher risk of any CVD during DCCT/EDIC (HR=1.16 per 20 nM higher levels of plasma kallikrein; p=0.0177) as well as over the EDIC-only period (HR=1.22; p=0.0024). The association between plasma kallikrein levels and the risk of any CVD remained significant during the EDIC follow-up after adjustment for age and mean HbA1c (HR=1.20; p=0.0082) and in the fully adjusted model for other CVD risk factors (HR=1.17; p=0.0330). For MACE, higher plasma kallikrein levels were associated with higher risk in unadjusted (HR=1.25; p=0.0145), minimally adjusted (HR=1.23; p=0.0417, and fully adjusted (HR=1.27; p=0.0328) models during EDIC-only. These novel findings indicate that plasma kallikrein level associates with the risk of any CVD and MACE in T1D individuals.

scholarly journals Genetic Risk Factors for CVD in Type 1 Diabetes: the DCCT/EDIC Study

2021 ◽  
Author(s):  
Ionut Bebu ◽  
Sareh Keshavarzi ◽  
Xiaoyu Gao ◽  
Barbara H. Braffett ◽  
Angelo J. Canty ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Genetic Factors ◽  
Risk Scores ◽  
Major Adverse Cardiovascular Events ◽  
Cvd Risk ◽  
Individual Snps

<b>Background</b> The role of genetic factors on the risk of cardiovascular disease (CVD) risk in type 1 diabetes remains unknown. We therefore examined whether previously identified genetic factors for coronary artery disease (CAD) are associated with the risk of CVD <i>above and beyond</i> established demographic and clinical factors in The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study. <p><b>Methods</b> Polygenic risk scores (PRS) and individual genetic variants identified in previous studies were obtained from genome-wide genotyping performed in 1371 DCCT/EDIC participants. Two composite CVD outcomes were considered: major adverse cardiovascular events (MACE) (CVD death or non-fatal myocardial infarction or stroke) and any-CVD (MACE plus confirmed angina, silent MI, revascularization, or congestive heart failure). Cox proportional hazards models assessed the association between the genetic factors and the risk of CVD when adjusted for other factors (including age, lipids, blood pressure and glycemia). </p> <p><b>Results</b> CAD PRS was strongly associated with the subsequent risk of any-CVD (42% and 38% higher risk per 1 standard deviation (SD) increase in unadjusted and fully adjusted models, respectively, p<0.0001), and with the risk of MACE (50% and 40% higher risk per 1SD increase in unadjusted and fully adjusted models, respectively, p<0.0001). Several individual SNPs were also nominally associated with the risk of any-CVD and MACE.</p> <p><b>Conclusions </b>Genetic factors are associated with the risk of subsequent cardiovascular disease in individuals with type 1 diabetes, above and beyond the effect of established risk factors such as age, lipids, blood pressure and glycemia. </p>

scholarly journals Genetic Risk Factors for CVD in Type 1 Diabetes: the DCCT/EDIC Study

2021 ◽  
Author(s):  
Ionut Bebu ◽  
Sareh Keshavarzi ◽  
Xiaoyu Gao ◽  
Barbara H. Braffett ◽  
Angelo J. Canty ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Genetic Factors ◽  
Risk Scores ◽  
Major Adverse Cardiovascular Events ◽  
Cvd Risk ◽  
Individual Snps

<b>Background</b> The role of genetic factors on the risk of cardiovascular disease (CVD) risk in type 1 diabetes remains unknown. We therefore examined whether previously identified genetic factors for coronary artery disease (CAD) are associated with the risk of CVD <i>above and beyond</i> established demographic and clinical factors in The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study. <p><b>Methods</b> Polygenic risk scores (PRS) and individual genetic variants identified in previous studies were obtained from genome-wide genotyping performed in 1371 DCCT/EDIC participants. Two composite CVD outcomes were considered: major adverse cardiovascular events (MACE) (CVD death or non-fatal myocardial infarction or stroke) and any-CVD (MACE plus confirmed angina, silent MI, revascularization, or congestive heart failure). Cox proportional hazards models assessed the association between the genetic factors and the risk of CVD when adjusted for other factors (including age, lipids, blood pressure and glycemia). </p> <p><b>Results</b> CAD PRS was strongly associated with the subsequent risk of any-CVD (42% and 38% higher risk per 1 standard deviation (SD) increase in unadjusted and fully adjusted models, respectively, p<0.0001), and with the risk of MACE (50% and 40% higher risk per 1SD increase in unadjusted and fully adjusted models, respectively, p<0.0001). Several individual SNPs were also nominally associated with the risk of any-CVD and MACE.</p> <p><b>Conclusions </b>Genetic factors are associated with the risk of subsequent cardiovascular disease in individuals with type 1 diabetes, above and beyond the effect of established risk factors such as age, lipids, blood pressure and glycemia. </p>

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