Long-term predictors of coronary artery disease and mortality in type 1 diabetes

We assessed clinical and biochemical predictors of death and/or cardiovascular disease in 147 type 1 diabetes mellitus (DM) patients followed-up for 14 years. At follow-up, 28 of patients (19%) had died, and 25 patients (18%) had developed or died of coronary artery disease (CAD). At baseline, those who died had significantly higher serum creatinine (P=0.001) and urine albumin/ creatinine ratio (p=0.016), greater prevalence of retinopathy (p=0.006), lower serum apolipoprotein Al (p= 0.046), and lower daily insulin dose (P = 0.024) than those who survived. CAD patients had a longer duration of diabetes (p <0.001), were older at the onset of diabetes and at presentation (p=0.001), and had higher prevalences of retinopathy (p=0.005) and neuropathy (p= 0.016). The CAD group also had higher baseline serum creatinine (p = 0.02), lower HDL cholesterol (p=0.004) and apolipoprotein Al (p=0.007) and higher LDL cholesterol (p=0.028) and apolipoprotein B concentrations (p = 0.027). Under logistic regression analysis (adjusted for age and sex), baseline urine albumin/creatinine ratio (p= 0.003), presence of retinopathy (p = 0.004), serum creatinine (p=0.028), and serum urea (p=0.034) were the most powerful predictors of mortality, while duration of diabetes (p <0.0001), baseline HDL cholesterol (p=0.012), serum creatinine (p=0.02), apolipoprotein B (p=0.038), LDL cholesterol (p=0.039), and systolic blood pressure (p=0.055) were the strongest predictors of CAD. These findings emphasize the role of abnormal lipoprotein metabolism in the development of CAD in type 1 DM. Indicators of renal impairment and the presence of retinopathy seem to be of greater importance in predicting overall mortality.