Aims: To evaluate burden of cardiovascular risk factors and associations with cardiovascular disease (CVD) among adults with type 1 diabetes attending Australian diabetes centers.

Methods: De-identified, prospectively collected data from patients with type 1 diabetes aged ≥18 years included in ANDA-2015 were analysed. Cardiovascular risk factors (age, sex, diabetes duration, HbA1c, BP, high density lipoprotein-cholesterol (HDL-C), BMI, smoking status and albuminuria) and associations with CVD inclusive of stroke, myocardial infarction, coronary artery bypass graft/angioplasty and peripheral vascular disease were assessed. Likelihood ratio test and restricted cubic splines assessed for interactions and non-linear associations. Discriminatory ability of multivariate models was assessed with area under the receiver operating characteristic curves (AUC).

Results: Data from 1,169 patients were analysed. Median (IQR) age and diabetes duration were 37.0 (24.9-52.0) and 16.0 (8.0-27.0) years respectively. Cardiovascular risk factors were prevalent including hypertension (22%), dyslipidemia (89%), overweight or obesity (56%), ever smoking (39%), albuminuria (31%), and an HbA1c >7.0% (53mmol/mol) (81%). Older age, longer diabetes duration, smoking and antihypertensive use were positively associated, while higher HDL-C was negatively associated with CVD (all p<0.05). Association with CVD and diabetes duration remained constant until 20 years when a linear increase was noted. The multivariate model demonstrated good discriminatory ability for CVD (AUC 0.88; 95% CI 0.85-0.92).

Conclusions: Cardiovascular risk factors were prevalent and strongly associated with CVD among adults with type 1 diabetes. Given the approximate J-shaped association between diabetes duration and CVD, the impact of cardiovascular risk stratification and management before and after 20 years duration will need to be further assessed.

Disclosure

A.J. Pease: None. A. Earnest: None. N. Nanayakkara: None. S. Ranasinha: None. J.R. Flack: None. W.A. Davis: Speaker's Bureau; Self; Eli Lilly and Company. Speaker's Bureau; Spouse/Partner; Novo Nordisk A/S. Advisory Panel; Spouse/Partner; Novo Nordisk A/S. Research Support; Spouse/Partner; Novo Nordisk A/S. Other Relationship; Spouse/Partner; Novo Nordisk A/S. Speaker's Bureau; Spouse/Partner; Merck Sharp & Dohme Corp.. Advisory Panel; Spouse/Partner; Merck Sharp & Dohme Corp.. Speaker's Bureau; Spouse/Partner; AstraZeneca. Advisory Panel; Spouse/Partner; AstraZeneca. Speaker's Bureau; Spouse/Partner; Boehringer Ingelheim GmbH, Pfizer Inc.. G.M. Kilmartin: None. N. Wischer: None. S. Zoungas: Advisory Panel; Self; AstraZeneca.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.