Coronary Artery Disease Events and Carotid Intima-Media Thickness in Type 1 Diabetes in the DCCT/EDIC Cohort

Joseph F Polak, Jye-Yu C Backlund, Matt Budoff, Philip Raskin, Ionut Bebu, John M Lachin, DCCT/EDIC Research Group, Joseph F Polak, Jye-Yu C Backlund, Matt Budoff, Philip Raskin, Ionut Bebu, John M Lachin, DCCT/EDIC Research Group

Abstract

Background Carotid artery intima-media thickness (IMT) is associated with the risk of subsequent cardiovascular events in the general population. This association has not been established in type 1 diabetes. Methods and Results We studied if carotid IMT is associated with the risk of a first coronary artery disease event in participants with type 1 diabetes in the EDIC (Epidemiology of Diabetes Interventions and Complications) study, the long-term observational follow-up of the DCCT (Diabetes Control and Complications Trial). Between 1994 and 1996, common carotid artery and internal carotid artery IMT were measured with high-resolution ultrasound in 1309 study participants with a mean age of 35 years and diabetes duration of 13.8 years; 52% were men. Cox proportional hazards models evaluated the association of standardized common carotid artery IMT and internal carotid artery IMT with subsequent cardiovascular events over the next 17 years. Models were adjusted for age, sex, mean hemoglobin A1c levels, and traditional cardiovascular risk factors. Associations of common carotid artery IMT with subsequent CAD were significant after adjustment for imaging device, sex, and age (hazard ratio [HR], 1.23 per 0.09 mm [95% CI, [1.04-1.45]; P=0.0141), but did not remain significant after further adjustment for traditional risk factors and hemoglobin A1c (HR, 1.14 per 0.09 mm [95% CI, 0.97-1.33]; P=0.1206). No significant associations with subsequent coronary artery disease events were seen for internal carotid artery IMT. Conclusions In the DCCT/EDIC cohort with type 1 diabetes, common carotid artery IMT, but not internal carotid artery IMT, is weakly associated with subsequent coronary artery events, an association eliminated after adjusting for coexistent traditional cardiovascular risk factors. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00360815 and NCT00360893.

Keywords: carotid intima‐media thickness; coronary artery disease; type 1 diabetes.

Figures

Figure 1. EDIC (Epidemiology of Diabetes Interventions…
Figure 1. EDIC (Epidemiology of Diabetes Interventions and Complications) participants flowchart.
CAD indicates coronary artery disease; CVD, cardiovascular disease; DCCT, Diabetes Control and Complications Trial; and IMT, intima‐media thickness.
Figure 2. Cumulative incidence of cardiovascular disease…
Figure 2. Cumulative incidence of cardiovascular disease by quartiles (Q) of common carotid artery (CCA) and internal carotid artery (ICA) intima‐media thickness (IMT).
A, Cumulative incidence of coronary artery disease (CAD) separately by quartiles of CCA IMT at EDIC (Epidemiology of Diabetes Interventions and Complications) year 1. B, Cumulative incidence of CAD separately by quartiles of ICA IMT at EDIC year 1.

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