Cargando…

Burden of cardiovascular risk factors and disease among patients with type 1 diabetes: results of the Australian National Diabetes Audit (ANDA)

BACKGROUND: Cardiovascular risk stratification is complex in type 1 diabetes. We hypothesised that traditional and diabetes-specific cardiovascular risk factors were prevalent and strongly associated with cardiovascular disease (CVD) among adults with type 1 diabetes attending Australian diabetes ce...

Descripción completa

Detalles Bibliográficos
Autores principales: Pease, Anthony, Earnest, Arul, Ranasinha, Sanjeeva, Nanayakkara, Natalie, Liew, Danny, Wischer, Natalie, Andrikopoulos, Sofianos, Zoungas, Sophia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984751/
https://www.ncbi.nlm.nih.gov/pubmed/29859534
http://dx.doi.org/10.1186/s12933-018-0726-8
_version_ 1783328656229138432
author Pease, Anthony
Earnest, Arul
Ranasinha, Sanjeeva
Nanayakkara, Natalie
Liew, Danny
Wischer, Natalie
Andrikopoulos, Sofianos
Zoungas, Sophia
author_facet Pease, Anthony
Earnest, Arul
Ranasinha, Sanjeeva
Nanayakkara, Natalie
Liew, Danny
Wischer, Natalie
Andrikopoulos, Sofianos
Zoungas, Sophia
author_sort Pease, Anthony
collection PubMed
description BACKGROUND: Cardiovascular risk stratification is complex in type 1 diabetes. We hypothesised that traditional and diabetes-specific cardiovascular risk factors were prevalent and strongly associated with cardiovascular disease (CVD) among adults with type 1 diabetes attending Australian diabetes centres. METHODS: De-identified, prospectively collected data from patients with type 1 diabetes aged ≥ 18 years in the 2015 Australian National Diabetes Audit were analysed. The burden of cardiovascular risk factors [age, sex, diabetes duration, glycated haemoglobin (HbA1c), blood pressure, lipid profile, body mass index, smoking status, retinopathy, renal function and albuminuria] and associations with CVD inclusive of stroke, myocardial infarction, coronary artery bypass graft surgery/angioplasty and peripheral vascular disease were assessed. Restricted cubic splines assessed for non-linearity of diabetes duration and likelihood ratio test assessed for interactions between age, diabetes duration, centre type and cardiovascular outcomes of interest. Discriminatory ability of multivariable models were assessed with area under the receiver operating characteristic (ROC) curves. RESULTS: Data from 1169 patients were analysed. Mean (± SD) age and median diabetes duration was 40.0 (± 16.7) and 16.0 (8.0–27.0) years respectively. Cardiovascular risk factors were prevalent including hypertension (21.9%), dyslipidaemia (89.4%), overweight/obesity (56.4%), ever smoking (38.5%), albuminuria (31.1%), estimated glomerular filtration rate < 60 mL/min/1.73 m(2) (10.3%) and HbA1c > 7.0% (53 mmol/mol) (81.0%). Older age, longer diabetes duration, smoking and antihypertensive therapy use were positively associated with CVD, while high density lipoprotein-cholesterol and diastolic blood pressure were negatively associated (p < 0.05). Association with CVD and diabetes duration remained constant until 20 years when a linear increase was noted. Longer diabetes duration also had the highest population attributable risk of 6.5% (95% CI 1.4, 11.6). Further, the models for CVD demonstrated good discriminatory ability (area under the ROC curve 0.88; 95% CI 0.84, 0.92). CONCLUSIONS: Cardiovascular risk factors were prevalent and strongly associated with CVD among adults with type 1 diabetes attending Australian diabetes centres. Given the approximate J-shaped association between type 1 diabetes duration and CVD, the impact of cardiovascular risk stratification and management before and after 20 years duration needs to be further assessed longitudinally. Diabetes specific cardiovascular risk stratification tools incorporating diabetes duration should be an important consideration in future guideline development. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12933-018-0726-8) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-5984751
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-59847512018-06-07 Burden of cardiovascular risk factors and disease among patients with type 1 diabetes: results of the Australian National Diabetes Audit (ANDA) Pease, Anthony Earnest, Arul Ranasinha, Sanjeeva Nanayakkara, Natalie Liew, Danny Wischer, Natalie Andrikopoulos, Sofianos Zoungas, Sophia Cardiovasc Diabetol Original Investigation BACKGROUND: Cardiovascular risk stratification is complex in type 1 diabetes. We hypothesised that traditional and diabetes-specific cardiovascular risk factors were prevalent and strongly associated with cardiovascular disease (CVD) among adults with type 1 diabetes attending Australian diabetes centres. METHODS: De-identified, prospectively collected data from patients with type 1 diabetes aged ≥ 18 years in the 2015 Australian National Diabetes Audit were analysed. The burden of cardiovascular risk factors [age, sex, diabetes duration, glycated haemoglobin (HbA1c), blood pressure, lipid profile, body mass index, smoking status, retinopathy, renal function and albuminuria] and associations with CVD inclusive of stroke, myocardial infarction, coronary artery bypass graft surgery/angioplasty and peripheral vascular disease were assessed. Restricted cubic splines assessed for non-linearity of diabetes duration and likelihood ratio test assessed for interactions between age, diabetes duration, centre type and cardiovascular outcomes of interest. Discriminatory ability of multivariable models were assessed with area under the receiver operating characteristic (ROC) curves. RESULTS: Data from 1169 patients were analysed. Mean (± SD) age and median diabetes duration was 40.0 (± 16.7) and 16.0 (8.0–27.0) years respectively. Cardiovascular risk factors were prevalent including hypertension (21.9%), dyslipidaemia (89.4%), overweight/obesity (56.4%), ever smoking (38.5%), albuminuria (31.1%), estimated glomerular filtration rate < 60 mL/min/1.73 m(2) (10.3%) and HbA1c > 7.0% (53 mmol/mol) (81.0%). Older age, longer diabetes duration, smoking and antihypertensive therapy use were positively associated with CVD, while high density lipoprotein-cholesterol and diastolic blood pressure were negatively associated (p < 0.05). Association with CVD and diabetes duration remained constant until 20 years when a linear increase was noted. Longer diabetes duration also had the highest population attributable risk of 6.5% (95% CI 1.4, 11.6). Further, the models for CVD demonstrated good discriminatory ability (area under the ROC curve 0.88; 95% CI 0.84, 0.92). CONCLUSIONS: Cardiovascular risk factors were prevalent and strongly associated with CVD among adults with type 1 diabetes attending Australian diabetes centres. Given the approximate J-shaped association between type 1 diabetes duration and CVD, the impact of cardiovascular risk stratification and management before and after 20 years duration needs to be further assessed longitudinally. Diabetes specific cardiovascular risk stratification tools incorporating diabetes duration should be an important consideration in future guideline development. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12933-018-0726-8) contains supplementary material, which is available to authorized users. BioMed Central 2018-06-02 /pmc/articles/PMC5984751/ /pubmed/29859534 http://dx.doi.org/10.1186/s12933-018-0726-8 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Investigation
Pease, Anthony
Earnest, Arul
Ranasinha, Sanjeeva
Nanayakkara, Natalie
Liew, Danny
Wischer, Natalie
Andrikopoulos, Sofianos
Zoungas, Sophia
Burden of cardiovascular risk factors and disease among patients with type 1 diabetes: results of the Australian National Diabetes Audit (ANDA)
title Burden of cardiovascular risk factors and disease among patients with type 1 diabetes: results of the Australian National Diabetes Audit (ANDA)
title_full Burden of cardiovascular risk factors and disease among patients with type 1 diabetes: results of the Australian National Diabetes Audit (ANDA)
title_fullStr Burden of cardiovascular risk factors and disease among patients with type 1 diabetes: results of the Australian National Diabetes Audit (ANDA)
title_full_unstemmed Burden of cardiovascular risk factors and disease among patients with type 1 diabetes: results of the Australian National Diabetes Audit (ANDA)
title_short Burden of cardiovascular risk factors and disease among patients with type 1 diabetes: results of the Australian National Diabetes Audit (ANDA)
title_sort burden of cardiovascular risk factors and disease among patients with type 1 diabetes: results of the australian national diabetes audit (anda)
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984751/
https://www.ncbi.nlm.nih.gov/pubmed/29859534
http://dx.doi.org/10.1186/s12933-018-0726-8
work_keys_str_mv AT peaseanthony burdenofcardiovascularriskfactorsanddiseaseamongpatientswithtype1diabetesresultsoftheaustraliannationaldiabetesauditanda
AT earnestarul burdenofcardiovascularriskfactorsanddiseaseamongpatientswithtype1diabetesresultsoftheaustraliannationaldiabetesauditanda
AT ranasinhasanjeeva burdenofcardiovascularriskfactorsanddiseaseamongpatientswithtype1diabetesresultsoftheaustraliannationaldiabetesauditanda
AT nanayakkaranatalie burdenofcardiovascularriskfactorsanddiseaseamongpatientswithtype1diabetesresultsoftheaustraliannationaldiabetesauditanda
AT liewdanny burdenofcardiovascularriskfactorsanddiseaseamongpatientswithtype1diabetesresultsoftheaustraliannationaldiabetesauditanda
AT wischernatalie burdenofcardiovascularriskfactorsanddiseaseamongpatientswithtype1diabetesresultsoftheaustraliannationaldiabetesauditanda
AT andrikopoulossofianos burdenofcardiovascularriskfactorsanddiseaseamongpatientswithtype1diabetesresultsoftheaustraliannationaldiabetesauditanda
AT zoungassophia burdenofcardiovascularriskfactorsanddiseaseamongpatientswithtype1diabetesresultsoftheaustraliannationaldiabetesauditanda