Carotid-Femoral Pulse Wave Velocity as a Risk Marker for Development of Complications in Type 1 Diabetes Mellitus

Ninna Hahn Tougaard, Simone Theilade, Signe Abitz Winther, Nete Tofte, Tarunveer Singh Ahluwalia, Tine Willum Hansen, Peter Rossing, Marie Frimodt-Møller, Ninna Hahn Tougaard, Simone Theilade, Signe Abitz Winther, Nete Tofte, Tarunveer Singh Ahluwalia, Tine Willum Hansen, Peter Rossing, Marie Frimodt-Møller

Abstract

Background The value of carotid-femoral pulse wave velocity (cfPWV) as risk factor for development of complications in type 1 diabetes mellitus remains to be determined. We investigated associations between cfPWV and renal outcomes, cardiovascular events, and all-cause mortality in people with type 1 diabetes mellitus. Methods and Results cfPWV was measured with SphygmoCor in 633 people with type 1 diabetes mellitus. Median (interquartile range) follow-up was 6.2 (5.8-6.7) years. End points included progression in albuminuria group, decline in estimated glomerular filtration rate (eGFR) ≥30%, end-stage kidney disease, cardiovascular event, mortality, and a composite renal end point. Hazard ratios (HRs) were calculated per 1-SD increase in cfPWV. Adjustments included age, sex, hemoglobin A1c, mean arterial pressure, body mass index, low-density lipoprotein cholesterol, smoking, urine albumin excretion rate, and eGFR. The cohort included 45% women, mean (SD) age was 54 (13) years, mean (SD) eGFR was 83.2 (27.9) mL/min per 1.73 m2, and mean (SD) cfPWV was 10.4 (3.3) m/s. Median (interquartile range) albumin excretion rate was 17 (17-63) mg/24 h. After adjustment, higher cfPWV was associated with increased hazard of progression in albuminuria (HR, 1.59; 95% CI, 1.10-2.32); decline in eGFR ≥30% (HR, 1.38; 95% CI, 1.06-1.79); cardiovascular event (HR, 1.31; 95% CI, 1.01-1.70); mortality (HR, 1.36; 95% CI, 1.00-1.85); and the composite renal end point (HR, 1.30; 95% CI, 1.04-1.63), but not with end-stage kidney disease (HR, 1.18; 95% CI, 0.62-2.26). Higher cfPWV was associated with steeper yearly increase in albumin excretion and steeper yearly decline in eGFR after adjustment (P=0.002 and P=0.01, respectively). Conclusions cfPWV was associated with increased hazard of renal outcomes, cardiovascular event, and mortality. cfPWV may be suited for risk stratification in type 1 diabetes mellitus.

Keywords: arterial stiffness; carotid-femoral pulse wave velocity; diabetic complications; type 1 diabetes mellitus.

Conflict of interest statement

S.A.W. reports that her salary during PhD employment was partly from Novo Nordisk. P.R. has received consultancy and/or speaking fees (to his institution) from AbbVie, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol‐Myers Squibb, Gilead, Eli Lilly, MSD, Merck, Mundi, Novo Nordisk, and Sanofi Aventis, and has received research grants from AstraZeneca and Novo Nordisk. The remaining authors have no disclosures to report.

Figures

Figure 1. Kaplan‐Meier survival plots for all‐cause…
Figure 1. Kaplan‐Meier survival plots for all‐cause mortality and for the composite renal end point in quartiles of carotid‐femoral pulse wave velocity.
Figure 2. Cumulative incidences of cardiovascular and…
Figure 2. Cumulative incidences of cardiovascular and renal outcomes with mortality as competing risk in quartiles of carotid‐femoral pulse wave velocity calculated with the Aalen‐Johansen estimator.
A, Cumulative incidence of progression in albuminuria group and all‐cause mortality. B, Cumulative incidence of estimated glomerular filtration rate (eGFR) decline and all‐cause mortality. C, Cumulative incidence of end‐stage kidney disease (ESKD) and all‐cause mortality. D, Cumulative incidence of cardiovascular events (CVEs) and death of other causes.

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