التفاصيل البيبلوغرافية
| العنوان: |
Risk Factors for First and Subsequent CVD Events in Type 1 Diabetes: The DCCT/EDIC Study. |
| المؤلفون: |
Bebu, Ionut1 ibebu@bsc.gwu.edu, Schade, David2, Braffett, Barbara1, Kosiborod, Mikhail3,4, Lopes-Virella, Maria5, Soliman, Elsayed Z.6, Herman, William H.7, Bluemke, David A.8, Wallia, Amisha9, Orchard, Trevor10, Lachin, John M.1, DCCT/EDIC Research Group |
| المصدر: |
Diabetes Care. Apr2020, Vol. 43 Issue 4, p867-874. 8p. |
| مصطلحات موضوعية: |
*TYPE 1 diabetes, *HYPERGLYCEMIA, *TRANSLUMINAL angioplasty, *MYOCARDIAL infarction, *CARDIOVASCULAR diseases risk factors, *DIABETES complications, *CORONARY artery bypass, *CARDIOVASCULAR disease prevention, *CARDIOVASCULAR disease diagnosis, *RESEARCH, *RESEARCH methodology, *CARDIOVASCULAR diseases, *HYPOGLYCEMIC agents, *DISEASE incidence, *BLOOD sugar, *EVALUATION research, *MEDICAL cooperation, *TREATMENT effectiveness, *COMPARATIVE studies, *RESEARCH funding, *DIABETIC angiopathies, *LONGITUDINAL method, *DISEASE complications |
| مستخلص: |
Objective: The Diabetes Control and Complications Trial (DCCT) and its observational follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) demonstrated the dominant role of glycemia, second only to age, as a risk factor for a first cardiovascular event in type 1 diabetes (T1D). We now investigate the association between established risk factors and the total cardiovascular disease (CVD) burden, including subsequent (i.e., recurrent) events.Research Design and Methods: CVD events in the 1,441 DCCT/EDIC participants were analyzed separately by type (CVD death, acute myocardial infarction [MI], stroke, silent MI, angina, percutaneous transluminal coronary angioplasty/coronary artery bypass graft [PTCA/CABG], and congestive heart failure [CHF]) or as composite outcomes (CVD or major adverse cardiovascular events [MACE]). Proportional rate models and conditional models assessed associations between risk factors and CVD outcomes.Results: Over a median follow-up of 29 years, 239 participants had 421 CVD events, and 120 individuals had 149 MACE. Age was the strongest risk factor for acute MI, silent MI, stroke, and PTCA/CABG, while glycemia was the strongest risk factor for CVD death, CHF, and angina, second strongest for acute MI and PTCA/CABG, third strongest for stroke, and not associated with silent MI. HbA1c was the strongest modifiable risk factor for a first CVD event (CVD: HR 1.38 [95% CI 1.21, 1.56] per 1% higher HbA1c; MACE: HR 1.54 [1.30, 1.82]) and also for subsequent CVD events (CVD: incidence ratio [IR] 1.28 [95% CI 1.09, 1.51]; MACE: IR 1.89 [1.36, 2.61]).Conclusions: Intensive glycemic management is recommended to lower the risk of initial CVD events in T1D. After a first event, optimal glycemic control may reduce the risk of recurrent CVD events and should be maintained. [ABSTRACT FROM AUTHOR] |
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