Modification of the Association Between Severe Hypoglycemia and Ischemic Heart Disease by Surrogates of Vascular Damage Severity in Type 1 Diabetes During ∼30 Years of Follow-up in the DCCT/EDIC Study

Diabetes Care ◽  
2021 ◽  
pp. dc202757
Author(s):  
Elke R. Fahrmann ◽  
Laura Adkins ◽  
Henry K. Driscoll
2021 ◽  
Author(s):  
Elke R. Fahrmann ◽  
Laura Adkins ◽  
Henry K. Driscoll

OBJECTIVE <p>Literature suggests that severe hypoglycemia (SH) may be linked to cardiovascular events only in older individuals with high cardiovascular risk score (CV-score). Whether a potential relationship between any-SH and cardiovascular disease exists and whether it is conditional on vascular damage severity in a young type 1 diabetes (T1D) cohort without apparent macro-vascular and no or mild-to-moderate micro-vascular complications at baseline is unknown.</p> <p>RESEARCH DESIGN AND METHODS</p> <p>We evaluated data of 1441 Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) volunteers (diabetes duration 1-15 years) followed for ~30 years. Time-dependent associations between any-SH, interactions of any-SH with surrogates of baseline micro-/macro- vascular damage severity (diabetes duration, Early Treatment Diabetic Retinopathy Study scale (ETDRS), Diabetes Complications Severity Index (DCSI), or CV-scores) and ischemic heart disease (IHD: death, silent/nonfatal myocardial infarct, revascularization, or confirmed angina) were analyzed.</p> <p>RESULTS</p> <p>Without interactions, in the minimal adjusted model controlling for confounding bias by age and HbA1c, SH was a significant IHD factor (p~0.003). SH remained a significant factor for IHD in fully adjusted models (p<0.05). In models with interactions, interactions between SH and surrogates of microvascular complications severity, but not between SH and CV-score, were significant. Hazard ratios for IHD based on SH increased 1.19-fold, 1.32-fold, and 2.21-fold for each additional year of diabetes duration, ETDRS-unit, and DCSI-unit, respectively. At time of IHD event, ~15% of 110 participants with SH had high CV-scores.</p> <p> </p> <p>CONCLUSION</p> <p>In a young T1D cohort with no baseline macrovascular complications, surrogates of baseline microvascular damage severity impact the effect of SH on IHD. Older age with high CV-score per se is not mandatory for an association of SH with IHD. However, the association is multifactorial.</p>


2021 ◽  
Author(s):  
Elke R. Fahrmann ◽  
Laura Adkins ◽  
Henry K. Driscoll

OBJECTIVE <p>Literature suggests that severe hypoglycemia (SH) may be linked to cardiovascular events only in older individuals with high cardiovascular risk score (CV-score). Whether a potential relationship between any-SH and cardiovascular disease exists and whether it is conditional on vascular damage severity in a young type 1 diabetes (T1D) cohort without apparent macro-vascular and no or mild-to-moderate micro-vascular complications at baseline is unknown.</p> <p>RESEARCH DESIGN AND METHODS</p> <p>We evaluated data of 1441 Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) volunteers (diabetes duration 1-15 years) followed for ~30 years. Time-dependent associations between any-SH, interactions of any-SH with surrogates of baseline micro-/macro- vascular damage severity (diabetes duration, Early Treatment Diabetic Retinopathy Study scale (ETDRS), Diabetes Complications Severity Index (DCSI), or CV-scores) and ischemic heart disease (IHD: death, silent/nonfatal myocardial infarct, revascularization, or confirmed angina) were analyzed.</p> <p>RESULTS</p> <p>Without interactions, in the minimal adjusted model controlling for confounding bias by age and HbA1c, SH was a significant IHD factor (p~0.003). SH remained a significant factor for IHD in fully adjusted models (p<0.05). In models with interactions, interactions between SH and surrogates of microvascular complications severity, but not between SH and CV-score, were significant. Hazard ratios for IHD based on SH increased 1.19-fold, 1.32-fold, and 2.21-fold for each additional year of diabetes duration, ETDRS-unit, and DCSI-unit, respectively. At time of IHD event, ~15% of 110 participants with SH had high CV-scores.</p> <p> </p> <p>CONCLUSION</p> <p>In a young T1D cohort with no baseline macrovascular complications, surrogates of baseline microvascular damage severity impact the effect of SH on IHD. Older age with high CV-score per se is not mandatory for an association of SH with IHD. However, the association is multifactorial.</p>


Diabetes Care ◽  
2016 ◽  
Vol 39 (12) ◽  
pp. 2288-2295 ◽  
Author(s):  
Gilberto Velho ◽  
Ray El Boustany ◽  
Guillaume Lefèvre ◽  
Kamel Mohammedi ◽  
Frédéric Fumeron ◽  
...  

Diabetes Care ◽  
2013 ◽  
Vol 37 (1) ◽  
pp. 144-148 ◽  
Author(s):  
Valma Harjutsalo ◽  
Christine Maric-Bilkan ◽  
Carol Forsblom ◽  
Per-Henrik Groop

2010 ◽  
Vol 24 (4) ◽  
pp. 223-228 ◽  
Author(s):  
Jakob Grauslund ◽  
Trine M.M. Jørgensen ◽  
Mads Nybo ◽  
Anders Green ◽  
Lars M. Rasmussen ◽  
...  

Circulation ◽  
2020 ◽  
Vol 142 (9) ◽  
pp. 841-857 ◽  
Author(s):  
Sripal Bangalore ◽  
David J. Maron ◽  
Gregg W. Stone ◽  
Judith S. Hochman

Background: Revascularization is often performed in patients with stable ischemic heart disease. However, whether revascularization reduces death and other cardiovascular outcomes is uncertain. Methods: We conducted PUBMED/EMBASE/Cochrane Central Register of Controlled Trials searches for randomized trials comparing routine revascularization versus an initial conservative strategy in patients with stable ischemic heart disease. The primary outcome was death. Secondary outcomes were cardiovascular death, myocardial infarction (MI), heart failure, stroke, unstable angina, and freedom from angina. Trials were stratified by percent stent use and by percent statin use to evaluate outcomes in contemporary trials. Results: Fourteen randomized clinical trials that enrolled 14 877 patients followed up for a weighted mean of 4.5 years with 64 678 patient-years of follow-up fulfilled our inclusion criteria. Most trials enrolled patients with preserved left ventricular systolic function and low symptom burden, and excluded patients with left main disease. Revascularization compared with medical therapy alone was not associated with a reduced risk of death (relative risk [RR], 0.99 [95% CI, 0.90–1.09]). Trial sequential analysis showed that the cumulative z-curve crossed the futility boundary, indicating firm evidence for lack of a 10% or greater reduction in death. Revascularization was associated with a reduced nonprocedural MI (RR, 0.76 [95% CI, 0.67–0.85]) but also with increased procedural MI (RR, 2.48 [95% CI, 1.86–3.31]) with no difference in overall MI (RR, 0.93 [95% CI, 0.83–1.03]). A significant reduction in unstable angina (RR, 0.64 [95% CI, 0.45–0.92]) and increase in freedom from angina (RR, 1.10 [95% CI, 1.05–1.15]) was also observed with revascularization. There were no treatment-related differences in the risk of heart failure or stroke. Conclusions: In patients with stable ischemic heart disease, routine revascularization was not associated with improved survival but was associated with a lower risk of nonprocedural MI and unstable angina with greater freedom from angina at the expense of higher rates of procedural MI. Longer-term follow-up of trials is needed to assess whether reduction in these nonfatal spontaneous events improves long-term survival.


Diabetes ◽  
1970 ◽  
Vol 19 (12) ◽  
pp. 938-943 ◽  
Author(s):  
J. B. Herman ◽  
J. H. Medalie ◽  
H. A. Kahn ◽  
H. N. Neufeld ◽  
E. Riss ◽  
...  

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