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.
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.