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Nephropathy, but not retinopathy, is associated with the development of heart disease in Type 1 diabetes: a 12‐year observation study of 462 patients
Author(s) -
Torffvit O.,
LövestamAdrian M.,
Agardh E.,
Agardh C.D.
Publication year - 2005
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2005.01476.x
Subject(s) - medicine , nephropathy , retinopathy , diabetes mellitus , diabetic retinopathy , disease , heart disease , type 2 diabetes , ophthalmology , endocrinology
Aims To study the occurrence of heart disease and death in Type 1 diabetic patients and evaluate whether presence of microangiopathy, i.e. nephropathy and retinopathy, was associated with the outcome. Methods A 12‐year observation study of 462 Type 1 diabetic patients without a previous history of heart disease at baseline who were treated under routine care in a hospital out‐patient clinic. Results A total of 85 patients developed signs of heart disease, i.e. myocardial infarction ( n = 41), angina ( n = 23), and heart failure ( n = 17) and 56 patients died. The mortality for patients without signs of heart disease during the observation period was 7.6% compared with 51% in patients with myocardial infarction ( P < 0.001), 26% in patients with angina ( P < 0.01) and 65% in patients with heart failure ( P < 0.001). The relative risk for death was 9.0 ( P < 0.001) and 2.5 ( P < 0.05) times higher in patients with macroalbuminuria and microalbuminuria, respectively. The risk for cardiovascular death was 18.3 times ( P < 0.001) higher in patients with macroalbuminuria compared with patients with normoalbuminuria. In patients with sight‐threatening retinopathy, the relative risk for death was 7.0 times higher ( P < 0.01) and the risk for coronary heart disease events 4.4 times higher ( P < 0.05) compared with patients with no retinopathy. However, when retinopathy was adjusted for presence of macroalbuminuria, this association disappeared. Conclusion This study shows a high incidence of heart disease in patients with Type 1 diabetes. The worse prognosis was seen in patients with sight‐threatening retinopathy and macroalbuminuria and microalbuminuria at baseline. Macroalbuminuria and microalbuminuria were independently associated with a high risk for heart disease and death while the association with sight‐threatening retinopathy only occurred in the presence of nephropathy.