Among young adults with type 1 diabetes, 10.9% had coronary artery calcification, with smoking (P=0.03) and elevated Lp(a) (P=0.05) independently predicting its presence.
Cross-Sectional (n=101)
What is the prevalence of and what are the risk factors for early coronary artery calcification in young adults with type 1 diabetes?
Early coronary artery calcification is present in nearly 11% of young adults with type 1 diabetes, with smoking and elevated Lp(a) identified as independent risk factors.
Effect estimate: nearly five times more likely (smoking); 10% increased risk per 0.36-mm/l increment (Lp[a])
p-value: p=0.03 (smoking); 0.05 (Lp[a])
OBJECTIVE: Type 1 diabetes increases the risk for coronary artery disease (CAD), but limited information is available regarding the early natural history of this process. Electron beam tomography (EBT) can measure coronary artery calcification (CAC), an early marker for CAD. This study was designed to assess the prevalence and risk factors for CAC in young adults with established type 1 diabetes. RESEARCH DESIGN AND METHODS: A total of 101 subjects aged 17-28 years with type 1 diabetes of over 5 years' duration and no history of heart disease underwent cardiac EBT with calcium scoring. Medical histories were obtained and physical examinations were conducted to document the presence of cardiac risk factors as well as evidence of microvasculopathy and diabetic arthropathy. Laboratory evaluation included measurement of fasting lipoproteins, homocysteine concentration, lipoprotein(a) Lp(a), urinary microalbumin, and HbA(1c). Contingency table analysis was used to assess bivariate relationships. Logistic regression was employed to construct a parsimonious model of independent risk factors. RESULTS: Eleven subjects (10.9%) had CAC. Smokers were nearly five times more likely than nonsmokers to have CAC (P = 0.03). In addition, each 0.36-mm/l increment of Lp(a) was associated with a 10% increased risk for CAC (P = 0.05) after controlling for potentially confounding factors. There was no association of other CAD or diabetes risk factors studied with CAC. CONCLUSIONS: The prevalence of early CAD as evidenced by CAC in young adults with type 1 diabetes is significant. Smoking and Lp(a) levels independently predict the presence of CAC. Additional study is necessary to delineate the natural history of CAC and the role of risk factor modification to prevent progression of CAD in this high-risk population.
Starkman et al. (Sat,) conducted a cross-sectional in Type 1 diabetes (n=101). Smoking and elevated Lipoprotein(a) vs. Nonsmokers and lower Lipoprotein(a) was evaluated on Presence of coronary artery calcification (CAC) (nearly five times more likely (smoking); 10% increased risk per 0.36-mm/l increment (Lp[a]), p=0.03 (smoking); 0.05 (Lp[a])). Among young adults with type 1 diabetes, 10.9% had coronary artery calcification, with smoking (P=0.03) and elevated Lp(a) (P=0.05) independently predicting its presence.
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