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Traditional risk factors appear to be more important than glycemic control in predicting coronary artery disease (CAD) among patients with type 1 diabetes. That, according to results of the prospective Pittsburgh Epidemiology of Diabetes Complications (PEDC) Study. ” The good news is that not all people with type 1 diabetes are insulin resistant, and for them the risk of heart disease may not be as high,” lead author Dr. Trevor J. Orchard commented in a University of Pittsburgh Medical Center press release. However, “reducing or preventing insulin resistance through exercise, weight loss and possibly medication may help people with type 1 diabetes avoid heart disease,” he adds.
Between 1986 and 1988, Dr. Orchard’s group examined 603 subjects with type 1 diabetes, mean age 28 years, who were free of prevalent CAD. They discuss their findings in the May issue of Diabetes Care.
During 10 years of follow-up, incident CAD events occurred in 108 subjects. These included 5 CAD deaths, 25 nonfatal MIs, 12 cases of coronary stenosis of 50% or greater, 49 cases of angina and 17 of ischemic ECG changes.
Diabetes duration, hypertension, WBC, HDL-cholesterol, non-HDL cholesterol and smoking history independently predicted CAD. The average estimated glucose disposal rate, which is based on HbA1, waist/hip ratio and hypertension, was lower in patients with incident CAD and was an independent predictor of CAD, MI, and coronary stenosis.
There was no positive association between hemoglobin A1 (HbA1) and CAD, a finding that the authors call “concerning and intriguing.” They point out that earlier research has indicated a relationship between HbA1 and lower extremity arterial disease (LEAD).
Therefore, they theorize that “though hyperglycemia leads to more extensive atherosclerosis, the plaques so formed are more stable and thus less likely to rupture and case acute coronary events.”
” The prediction of angina by greater smoking and depressive symptoms (and possibly lower HbA1) raises the possibility that a certain subset may have a susceptible… underlying psychological state that might exacerbate any tendencies to coronary artery spasm and is associated with smoking and possibly increased concern about blood sugar control,” the EDC investigators add. Diabetes Care 2003;26:000-000.