Cumulative exposures to glycaemia and lipids are associated with coronary artery disease in type 1 diabetes: a call for action.

Abstract

Background: Hyperglycaemia and dyslipidaemia are well-known risk factors for coronary artery disease (CAD) in type 1 diabetes. The impact of long-term cumulative exposure to these risk factors is less explored. We investigated the relationship between cumulative glycaemic and lipid exposure and CAD in individuals with type 1 diabetes.

Methods: This longitudinal study included 3495 adults with type 1 diabetes from the FinnDiane cohort, without end-stage kidney disease and no history of CAD or stroke at the study baseline. Total cumulative glycaemic exposure (CGE_tot) and cumulative hyperglycaemic exposure (CGE_hg), accounting only for time spent above an HbA_1c of 53 mmol/mol (7%), were calculated from diabetes diagnosis.

Results: During a median follow-up of 19.38 years, 534 participants had their first-ever CAD event. CGE_hg (odds ratio 1.03 [95% CI 1.02-1.05], p < 0.001) and cumulative exposure to LDL cholesterol, triglycerides, and non-HDL cholesterol all significantly increased the odds for incident CAD. The highest tertile of CGE_hg associated with a twofold odds increase for incident CAD. CGE_tot was not significantly associated with CAD after adjusting for cumulative lipid exposure.

Conclusions: Both hyperglycaemia and dyslipidaemia are independently associated with CAD in type 1 diabetes. These findings emphasize the importance of reaching an HbA_1c below 53 mmol/mol (7%) and minimizing lipid exposure, as well as calling on health care professionals to not settle for suboptimal care, but to continue their support and encouragement towards better management of diabetes.