Arterial Stiffness Predicts Mortality in Individuals With Type 1 Diabetes

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Tynjälä , A , Forsblom , C , Harjutsalo , V , Groop , P-H & Gordin , D 2020 , ' Arterial Stiffness Predicts Mortality in Individuals With Type 1 Diabetes ' , Diabetes Care , vol. 43 , no. 9 , pp. 2266-2271 .

Title: Arterial Stiffness Predicts Mortality in Individuals With Type 1 Diabetes
Author: Tynjälä, Anniina; Forsblom, Carol; Harjutsalo, Valma; Groop, Per-Henrik; Gordin, Daniel
Contributor organization: Nefrologian yksikkö
HUS Abdominal Center
Helsinki University Hospital Area
University of Helsinki
CAMM - Research Program for Clinical and Molecular Metabolism
Faculty of Medicine
Research Programs Unit
Department of Medicine
Per Henrik Groop / Principal Investigator
University Management
Date: 2020-09
Language: eng
Number of pages: 6
Belongs to series: Diabetes Care
ISSN: 0149-5992
Abstract: 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.
3121 General medicine, internal medicine and other clinical medicine
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: acceptedVersion

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