Arterial Stiffness Predicts Mortality in Individuals With Type 1 Diabetes

OBJECTIVE Type 1 diabetes is accompanied by a significant burden of cardiovascular disease (CVD), which is poorly explained by traditional risk factors. We therefore aimed to explore whether arterial stiffness estimated by the augmentation index (AIx) predicts mortality in individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS After baseline examination comprising pulse wave analysis by applanation tonometry alongside assessment of traditional cardiovascular risk factors, 906 individuals with type 1 diabetes from the Finnish Diabetic Nephropathy (FinnDiane) Study were followed up for a median of 8.2 years (interquartile range 5.7-9.7). Associations between baseline hemodynamics, including AIx, and all-cause mortality as well as a composite of cardiovascular and/or diabetes-related mortality were investigated using multivariable Cox regression models. RESULTS The 67 individuals who died during follow-up had higher baseline AIx (median 28% [interquartile range 21-33] vs. 19% [9-27];P<0.001) compared with those alive. This association was independent of conventional risk factors (age, sex, BMI, HbA(1c), estimated glomerular filtration rate [eGFR], and previous CVD event) in Cox regression analysis (standardized hazard ratio 1.71 [95% CI 1.10-2.65];P= 0.017) and sustained in a subanalysis of individuals with chronic kidney disease. Similarly, higher AIx was associated with the composite secondary end point of cardiovascular and diabetes-related death (N= 53) after adjustments for sex, BMI, eGFR, previous CVD event, and height (standardized hazard ratio 2.30 [1.38-3.83];P= 0.001). CONCLUSIONS AIx predicts all-cause mortality as well as a composite cardiovascular and/or diabetes-related cause of death in individuals with type 1 diabetes, independent of established cardiovascular risk factors.Peer reviewe

Carotid intima-media thickness and arterial stiffness in relation to cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes

Aims To determine if arterial functional and structural changes are associated with underlying cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes. Methods We enrolled 186 individuals (47.8% men; median age 40.0, IQR 33.0-45.0 years) with type 1 diabetes (median diabetes duration of 21.6, IQR 18.2-30.3 years), and 30 age- and sex-matched healthy controls, as part of the Finnish Diabetic Nephropathy (FinnDiane) Study. All individuals underwent a biochemical work-up, brain magnetic resonance imaging (MRI), ultrasound of the common carotid arteries and arterial tonometry. Arterial structural and functional parameters were assessed by carotid intima-media thickness (CIMT), pulse wave velocity and augmentation index. Results Cerebral microbleeds (CMBs) were present in 23.7% and white matter hyperintensities (WMHs) in 16.7% of individuals with type 1 diabetes. Those with type 1 diabetes and CMBs had higher median (IQR) CIMT 583 (525 - 663) mu m than those without 556 (502 - 607) mu m, p = 0.016). Higher CIMT was associated with the presence of CMBs (p = 0.046) independent of age, eGFR, ApoB, systolic blood pressure, albuminuria, history of retinal photocoagulation and HbA(1c). Arterial stiffness and CIMT were increased in individuals with type 1 diabetes and WMHs compared to those without; however, these results were not independent of cardiovascular risk factors. Conclusions Structural, but not functional, arterial changes are associated with underlying CMBs in asymptomatic individuals with type 1 diabetes.Peer reviewe

Role of Systemic Factors in Improving the Prognosis of Diabetic Retinal Disease and Predicting Response to Diabetic Retinopathy Treatment

TOPIC: To review clinical evidence on systemic factors that might be relevant to update diabetic retinal disease (DRD) staging systems, including prediction of DRD onset, progression, and response to treatment.CLINICAL RELEVANCE: Systemic factors may improve new staging systems for DRD to better assess risk of disease worsening and predict response to therapy.METHODS: The Systemic Health Working Group of the Mary Tyler Moore Vision Initiative reviewed systemic factors individually and in multivariate models for prediction of DRD onset or progression (i.e., prognosis) or response to treatments (prediction).RESULTS: There was consistent evidence for associations of longer diabetes duration, higher glycosylated hemoglobin (HbA1c), and male sex with DRD onset and progression. There is strong trial evidence for the effect of reducing HbA1c and reducing DRD progression. There is strong evidence that higher blood pressure (BP) is a risk factor for DRD incidence and for progression. Pregnancy has been consistently reported to be associated with worsening of DRD but recent studies reflecting modern care standards are lacking. In studies examining multivariate prognostic models of DRD onset, HbA1c and diabetes duration were consistently retained as significant predictors of DRD onset. There was evidence of associations of BP and sex with DRD onset. In multivariate prognostic models examining DRD progression, retinal measures were consistently found to be a significant predictor of DRD with little evidence of any useful marginal increment in prognostic information with the inclusion of systemic risk factor data apart from retinal image data in multivariate models. For predicting the impact of treatment, although there are small studies that quantify prognostic information based on imaging data alone or systemic factors alone, there are currently no large studies that quantify marginal prognostic information within a multivariate model, including both imaging and systemic factors.CONCLUSION: With standard imaging techniques and ways of processing images rapidly evolving, an international network of centers is needed to routinely capture systemic health factors simultaneously to retinal images so that gains in prediction increment may be precisely quantified to determine the usefulness of various health factors in the prognosis of DRD and prediction of response to treatment.FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p

Arterial stiffness predicts all-cause mortality in type 1 diabetes

Tyypin 1 diabeetikoilla on muuhun väestöön nähden kohonnut riski sairastua sydän- ja verisuonitauteihin sekä kuolla ennenaikaisesti, mikä ei selity yksinomaan perinteisillä riskitekijöillä. Heidän valtimonsa jäykistyvät tunnetusti aikaisemmin, minkä on poikkileikkaustutkimuksissa osoitettu olevan yhteydessä diabeteksen mikro- ja makrovaskulaarisiin komplikaatioihin. Tämän seurantatutkimuksen tavoitteena oli selvittää, ennustaako valtimojäykkyys kokonaiskuolleisuutta tyypin 1 diabeetikoilla. Valtimojäykkyyden mittarina käytettiin pulssiaaltojen takaisinheijastumista kuvaavaa suhdelukua, augmentaatioindeksiä (AIx), jonka kohoaminen kertoo erityisesti pienten resistanssisuonten jäykistymisestä. AIx saadaan selville pulssiaaltoanalyysillä kajoamatonta applanaatiotonometriamentelmää käyttäen. Tutkimusaineisto koostui 906:sta tyypin 1 diabeetikosta, joilta määritettiin lähtötilanteessa vuosina 2001-2015 valtimojäykkyys, sydän- ja verisuonitautien riskitekijöitä sekä diabeteksen komplikaatioita osana FinnDiane-tutkimusta. Tilastokeskuksesta saatujen tietojen mukaan 67 potilasta oli kuollut seuranta-aikana, jonka mediaani oli 8.2 (5.7-9.7) vuotta. Heillä oli eloonjääneisiin verrattuna korkeampi AIx:n lähtöarvo (28 [21-33] vs. 19 [9-27] %, P < 0.001). Tämä yhteys säilyi merkittävänä Coxin regressioanalyysissä (riskitiheyssuhde 1.042 [1.007-1.078]), kun malli korjattiin perinteisillä riskitekijöillä (ikä, sukupuoli, painoindeksi, HbA1c, triglyseridit, munuaisfunktio sekä sairastettu sydän- ja verisuonitautitapahtuma). AIx valtimojäykkyyden mittarina ennusti itsenäisesti kokonaiskuolleisuutta tyypin 1 diabeetikoilla. Tutkimustieto valtimojäykkyyttä alentavien lääkeaineryhmien, kuten reniini-angiotensiinijärjestelmän estäjien ja natriumglukoosikuljettajaproteiini 2:n estäjien, tehosta ja turvallisuudesta tyypin 1 diabeteksessa lisääntyy jatkuvasti. Valtimojäykkyyden varhainen tunnistaminen näillä potilailla muiden sydän- ja verisuonitautien riskitekijöiden ohella voisi auttaa kohdistamaan tehokkaampaa hoitoa suuressa riskissä oleville yksilöille. (197 sanaa)The fact that individuals with type 1 diabetes (T1D) are at greater risk for cardiovascular disease and premature death, can only partly be explained by traditional risk factors. Interestingly, T1D is accompanied by arterial stiffening that correlates with microvascular and macrovascular complications. The aim of this study was to find out whether arterial stiffness predicts all-cause mortality in individuals with T1D. Augmentation index (AIx), a measure of arterial pulse wave reflections, is used to estimate stiffness in the resistance arteries and can be determined non-invasively from pulse wave analysis by applanation tonometry. The data consisted of 906 individuals with T1D from the FinnDiane Study that have been examined for arterial stiffness, cardiovascular risk factors and diabetic complications at baseline between 2001 and 2015. After a median follow-up of 8.2 (5.7-9.7) years, 67 individuals had died according to mortality data from Statistics Finland. They had higher baseline AIx (28 [21-33] vs. 19 [9-27] %, P < 0.001) compared to those alive. This association was independent of related risk factors (age, sex, BMI, HbA1c, triglycerides, renal function and past cardiovascular events) in Cox regression analysis (hazard ratio 1.042 [1.007-1.078], P = 0.017). Arterial stiffness estimated by AIx independently predicted all-cause mortality in T1D. Promising pharmacological agents counteracting arterial stiffness include inhibitors of the renin-angiotensin-aldosterone system and sodium-glucose co-transporter 2, and research data on their effect in individuals with T1D is constantly growing. Our finding suggests that detecting early arterial stiffening individuals with T1D could be useful in targeting a more aggressive treatment for high-risk individuals

Higher HbA(1c) variability is associated with increased arterial stiffness in individuals with type 1 diabetes

Correction: Volume22, Issue1 Article Number: 83 DOI: 10.1186/s12933-023-01813-8 Published:APR 8 2023Peer reviewe