Long-term predictors of coronary artery disease and mortality in type 1 diabetes

Abstract

We assessed clinical and biochemical predictors of death and/or cardiovascular disease in 147 type 1 diabetes mellitus (DM) patients followed-up for 14 years. At follow-up, 28 of patients (19%) had died, and 25 patients (18%) had developed or died of coronary artery disease (CAD). At baseline, those who died had significantly higher serum creatinine (p = 0.001) and urine albumin/creatinine ratio (p = 0.016), greater prevalence of retinopathy (p = 0.006), lower serum apolipoprotein A1 (p = 0.046), and lower daily insulin dose (p = 0.024) than those who survived. CAD patients had a longer duration of diabetes (p < 0.001), were older at the onset of diabetes and at presentation (p = 0.001), and had higher prevalences of retinopathy (p = 0.005) and neuropathy (p = 0.016). The CAD group also had higher baseline serum creatinine (p = 0.02), lower HDL cholesterol (p = 0.004) and apolipoprotein A1 (p = 0.007) and higher LDL cholesterol (p = 0.028) and apolipoprotein B concentrations (p = 0.027). Under logistic regression analysis (adjusted for age and sex), baseline urine albumin/creatinine ratio (p = 0.003), presence of retinopathy (p = 0.004), serum creatinine (p = 0.028), and serum urea (p = 0.034) were the most powerful predictors of mortality, while duration of diabetes (p < 0.0001), baseline HDL cholesterol (p = 0.012), serum creatinine (p = 0.02), apolipoprotein B (p = 0.038), LDL cholesterol (p = 0.039), and systolic blood pressure (p = 0.055), were the strongest predictors of CAD. These findings emphasize the role of abnormal lipoprotein metabolism in the development of CAD in type 1 DM. Indicators of renal impairment and the presence of retinopathy seem to be of greater importance in predicting overall mortality.