Moderation of the effect of glycemia on the risk of cardiovascular disease in type 1 diabetes: The DCCT/EDIC study

Authors

Ionut Bebu, The George Washington University
Barbara H. Braffett, The George Washington University
Trevor J. Orchard, University of Pittsburgh
Gayle M. Lorenzi, University of California, San Diego
David M. Nathan, Harvard Medical School
William H. Herman, University of Michigan, Ann Arbor
John M. Lachin, The George Washington University

Document Type

Journal Article

Publication Date

1-1-2021

Journal

Diabetes Research and Clinical Practice

Volume

171

DOI

10.1016/j.diabres.2020.108591

Keywords

Cardiovascular disease; Glycemia; Moderation; Type 1 diabetes

Abstract

Aims: We assessed whether and to what extent established cardiovascular disease (CVD) risk factors moderate (enhance/reduce) the effect of hyperglycemia on CVD outcomes in the long-term follow-up of the Diabetes Control and Complications Trial type 1 diabetes (T1D) cohort (N = 1441). Methods: Moderation of the effect of glycemia on subsequent risk of major adverse cardiovascular events (MACE: fatal or non-fatal myocardial infarction or stroke) and any-CVD (MACE plus confirmed angina, silent MI, revascularization, or congestive heart failure) was assessed separately using interaction terms between HbA1c and other risk factors in Cox proportional hazards models. Results: Over a median follow-up of 29 years, there were 120 MACE cases and 239 any-CVD cases. Higher pulse, higher triglycerides, use of calcium channel blockers, and presence of neuropathy individually enhanced (p < 0.01) the effect of glycemia on any-CVD. Higher pulse and triglyceride levels, albumin excretion rate, hypertension, and no family history of type 2 diabetes enhanced (p < 0.01) the effect of glycemia on MACE. Conclusions: Such moderation analyses identify subgroups with increased CVD risk who might especially benefit from earlier and/or more intensive glycemic control. Interventions treating modifiable moderating factors may independently reduce the risk of CVD and also reduce the risk associated with a higher HbA1c.

APA Citation

Bebu, I., Braffett, B., Orchard, T., Lorenzi, G., Nathan, D., Herman, W., & Lachin, J. (2021). Moderation of the effect of glycemia on the risk of cardiovascular disease in type 1 diabetes: The DCCT/EDIC study. Diabetes Research and Clinical Practice, 171 (). http://dx.doi.org/10.1016/j.diabres.2020.108591