407-P: Cardiac and Retinal Imaging Studies Suggest Comparable Protective Factors between Cardiovascular Disease and Retinopathy in Long Duration Type 1 Diabetes

In the Joslin Medalist Study (“Medalists”), which enrolled people with ≥50 years of type 1 diabetes (T1D), factors have been shown to individually protect against vascular complications, such as proliferative retinopathy (PDR), and possibly, cardiovascular disease (CVD). However, shared protective factors against these disease outcomes have not been demonstrated. Recently, Medalists underwent cardiac computed tomography (CT; n=67) and cardiac magnetic resonance imaging (CMR; n=54) for assessment of coronary artery calcification (CAC) and myocardial and aortic structure and function, respectively; as well as optical coherence tomography angiography for assessment of superficial (SCP) and deep (DCP) retinal capillary plexus density (n=28 eyes). In this cohort, CAC severity was associated with self-reported CVD history (p=0.04). CAC>200 was associated with PDR (p=0.03) and with lower density of both SCP (p=0.002) and DCP (p=0.047). Among the CMR parameters, lower ascending aortic distensibility, indicating higher stiffness, was found among participants with PDR (p=0.009), and was also associated with lower SCP density (p=0.037). Meanwhile, measures of myocardial strain (longitudinal, circumferential, and radial) were significantly lower in women and in those with CAC>200 (all p<0.05); likewise, Medalists with CAC>200 were also less likely to be female (p=0.02). The common association of CAC and aortic stiffness with PDR and SCP density suggests that protective markers of progression to angiogenesis (PDR) may have similarities with those protecting against coronary calcification and aortic dysfunction. Furthermore, the results highlight the important relationship between CAC, gender, and myocardial biomechanics in Medalists. Future proteomic and metabolomic studies using circulatory and retinal biosamples could be helpful in identifying common factors that can delay the onset of CVD and PDR.