1437-P: Blood Pressure (BP) Trajectories and 32-Year Cardiovascular Disease (CVD) Incidence in Women and Men with Type 1 Diabetes (T1D)

While women have lower BP compared to men, CVD risk has been shown to increase at lower BPs in T1D compared to the general population, raising the need to better understand sex-specific effects of BP on CVD risk in T1D. We thus examined associations between longitudinal systolic (SBP) and diastolic (DBP) BP trajectories and 32-year CVD incidence in the Pittsburgh Epidemiology of Diabetes Complications T1D cohort separately in women and men (n=300 and 304 free of CVD at 1986-88 baseline respectively, mean age 27, T1D duration 19 yrs). SBP and DBP were measured at baseline and 2, 4, 6, 8, 10, 18, 25, and 30 years’ follow-up (median 6 measures per person). Associations between longitudinal BPs and time to first CVD event, defined as the first instance of coronary artery disease or stroke, were assessed separately in women and men using joint models which estimate the longitudinal data process and time-to-event data process simultaneously. Models were adjusted for time-varying anti-hypertensive (AH) medication use status and baseline T1D duration, HbA1c, and other CVD risk factors (HbA1c, lipids, BMI, smoking, kidney markers). On average SBP was 5.3 mmHg lower (p<0.0001) and DBP 6.1 mmHg lower (p<0.0001) over follow-up in women vs. men. SBP increased similarly in women (0.48/yr) and men (0.46/yr) but DBP decreased faster in women (-0.28/yr vs. men -0.13/yr, p=0.02). AH rates were similar in men and women over time (p=0.25), increasing from ~10 to 70% over follow-up in both. After adjustment for time-varying AH use and baseline covariates, longitudinal SBP was similarly associated with CVD in both women (HR=1.03, p=0.001) and men (HR=1.03, p<0.001) while longitudinal DBP had a slightly stronger association in women (HR=1.06, p=0.004; men: HR=1.04, p=0.04). Our results suggest that despite being significantly lower over time, BP remains an important CVD risk factor in women with T1D. Thus, further research into sex-specific BP goals is warranted to improve CVD risk reduction.