Soedamah-Muthu, Sabita Suvarna; (2003) New and established risk factors for coronary heart disease in type 1 diabetic patients. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Aims: To assess which established risk factors are related to coronary heart disease (CHD) in type 1 diabetes. To investigate the role of inflammatory and endothelial markers in the prediction of CHD and to examine whether lipoprotein subclasses as measured by nuclear magnetic resonance (NMR) spectroscopy are related to coronary heart disease. Methods: Data from two large prospective clinic-based studies of type 1 diabetic patients were analysed: the EURODIAB Prospective Complications study (n=2329, 7 years) and the Epidemiology of Diabetes Complications Study (n=603, 9 years). Results: Both studies showed that age, duration of diabetes, lipids (fasting TG, HDL-c or non-HDL-c), smoking and blood pressure were important risk factors for CHD with similar hazard ratios. Albuminuria and waist-hip ratio were independent risk factors in EURODIAB PCS, but not in the EDC study. Increased sialic acid, white blood cell count and decreased serum albumin were independently related to incident CHD. Adhesion molecules (sVCAM-1, sICAM-1, sE-selectin) and cytokines (TNF-α, (urinary) TGF-pl/creatinine and IL-6) were positively associated with CHD in cross-sectional analyses, with a 1.4-2 fold increased risk. NMR spectroscopy measured lipoprotein subclasses improved the prediction of CHD. In univariate analyses, mainly triglyceride related lipoprotein subclasses (expressed in particle numbers) were associated with CHD. Conclusions: Risk factors, established in the general population (smoking, blood pressure, lipids), play an important role in the prediction of CHD in type 1 diabetes. Additional risk factors such as, duration of diabetes, albuminuria and WHR also seem to play an important role in the development of CHD in type 1 diabetes. Several inflammatory and endothelial markers are associated with CHD beyond the effect of established risk factors, but further research is needed to explore these associations prospectively. Furthermore, NMR spectroscopy measured lipoprotein subclasses, with mainly triglyceride-related lipoprotein subclasses, improved the prediction of CHD further.

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