Undiagnosed coronary artery disease in long-term type 1 diabetes. The Dialong study

Kristine Bech Holte; Mona Svanteson; Kristian Folkvord Hanssen; Ylva Haig; Svein Solheim; Tore Julsrud Berg

doi:10.1016/j.jdiacomp.2019.01.006

Undiagnosed coronary artery disease in long-term type 1 diabetes. The Dialong study

J Diabetes Complications. 2019 May;33(5):383-389. doi: 10.1016/j.jdiacomp.2019.01.006. Epub 2019 Jan 31.

Authors

Kristine Bech Holte¹, Mona Svanteson², Kristian Folkvord Hanssen³, Ylva Haig⁴, Svein Solheim⁵, Tore Julsrud Berg⁶

Affiliations

¹ Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: k.b.holte@medisin.uio.no.
² Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ The Norwegian Diabetics' Center, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁴ Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
⁵ Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Oslo, Norway.
⁶ Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; The Norwegian Diabetics' Center, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.

PMID: 30846232
DOI: 10.1016/j.jdiacomp.2019.01.006

Abstract

Aims: We studied the total prevalence of obstructive coronary artery disease (CAD), undiagnosed CAD and absent CAD in persons with ≥45-year duration of type 1 diabetes (T1D) versus controls, and associations with mean HbA_1c, LDL-cholesterol and blood pressure over 2-3 decades.

Methods: We included 76% (n = 103) of all persons with T1D diagnosed ≤1970 attending a diabetes center and 63 controls without diabetes. We collected 20-30 years of HbA_1c, LDL-cholesterol and blood pressure measurements. Participants without previously diagnosed coronary heart disease (CHD) underwent Computed Tomography Coronary Angiography (CTCA). Undiagnosed obstructive CAD was defined as any coronary stenosis >50% on CTCA, absent CAD as no detected plaque, and total obstructive CAD as either obstructive CAD on CTCA or previous CHD diagnosis.

Results: The prevalence of undiagnosed, absent and obstructive CAD was 24% (21/88), 16% (14/88) and 35% (36/103) in T1D versus 10% (6/60), 50% (30/60) and 14% (9/63) in controls (all p < 0.05). Mean HbA_1c was associated with undiagnosed obstructive CAD (OR 2.30 95% C.I. 1.13-4.69), while mean LDL-cholesterol was inversely associated with absent CAD (0.12, 0.04-0.43).

Conclusions: The prevalence of undiagnosed obstructive CAD was high (24%) in this cohort of long-term survivors with T1D. Mean LDL-cholesterol and HbA_1c were associated with CAD.

Keywords: Cholesterol, LDL; Computer Tomography Angiography; Coronary artery disease; Diabetes mellitus, type 1; Glycated Hemoglobin A.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Blood Pressure
Case-Control Studies
Cholesterol, LDL / blood
Coronary Artery Disease / diagnosis*
Coronary Artery Disease / epidemiology*
Cross-Sectional Studies
Diabetes Mellitus, Type 1 / complications*
Diabetes Mellitus, Type 1 / metabolism
Diabetes Mellitus, Type 1 / physiopathology
Female
Glycated Hemoglobin / metabolism
Humans
Male
Middle Aged
Norway
Prevalence
Risk Factors
Time Factors

Substances

Cholesterol, LDL
Glycated Hemoglobin A