Risk and protective factors for coronary atherosclerosis and myocardial dysfunction in individuals with long-duration type 1 diabetes.

IF 10.2 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetologia Pub Date : 2025-08-20 DOI:10.1007/s00125-025-06521-4

Marc Gregory Yu, Hetal Shah, Surya Jangolla, John Gauthier, Elizabeth Viebranz, I-Hsien Wu, Tanvi Chokshi, Kyoungmin Park, Qian Li, Ward Fickweiler, Mawra Jha, Jennifer Sun, Ron Blankstein, Connie Tsao, George L King

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引用次数: 0

Abstract

Aims/hypothesis: CVD remains a major cause of mortality in people with long-duration type 1 diabetes, even among those without diabetic kidney disease (DKD). We assessed biomarkers that may be associated with CVD risks among the Joslin 'Medalists', namely those with type 1 diabetes of ≥50 years.

Methods: In this cross-sectional study, participants were evaluated for self-reported CVD (n=1038), with subsets undergoing coronary artery calcium (CAC; n=142) and cardiac magnetic resonance (CMR; n=111) imaging. Using multivariable regression analysis, multiple circulating factors such as inflammatory biomarkers and osteopontin (n=300) were analysed for associations with CVD, CAC and CMR, adjusting for DKD and other cardiometabolic and glycaemic risk factors, including HbA_1c, continuous glucose monitor (n=102) metrics and advanced glycation end-products (n=200).

Results: Only 32% of participants had DKD (eGFR <60 ml/min per 1.73 m²), but 40% had CVD. Despite having excellent cardiometabolic management (mean blood pressure of 132/64 mmHg; LDL and HDL-cholesterol of 2.10 mmol/l and 1.69 mmol/l, respectively, and a median HbA_1c of 54.1 mmol/mol [7.1%]), participants exhibited a high CAC burden (median score 937), which did not differ between those with and without DKD (1136 vs 878, respectively). Among the glycaemic markers, HbA_1c, but not hypoglycaemia or glycaemic variability, remained associated with CVD (OR 1.40, p<0.01) in the non-DKD group compared with the DKD group. Similarly, among the inflammatory markers, only osteopontin was associated with CVD (β=0.50, p<0.01) in the non-DKD group compared with the DKD group.

Conclusions/interpretation: Ageing people with long-duration type 1 diabetes and without DKD, but with excellent cardiometabolic management, still possess a high burden of coronary atherosclerosis. Improving hyperglycaemia and mitigating inflammation, especially osteopontin, are potentially important for the management of CVD in long-duration type 1 diabetes.

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长期1型糖尿病患者冠状动脉粥样硬化和心肌功能障碍的危险因素和保护因素

目的/假设：心血管疾病仍然是长期1型糖尿病患者死亡的主要原因，即使在没有糖尿病肾病（DKD）的患者中也是如此。我们评估了Joslin“奖牌获得者”（即患有≥50岁的1型糖尿病的患者）中可能与CVD风险相关的生物标志物。方法：在这项横断面研究中，评估参与者自我报告的CVD (n=1038)，其中亚组接受冠状动脉钙化（CAC, n=142）和心脏磁共振（CMR, n=111）成像。采用多变量回归分析，分析了多种循环因素，如炎症生物标志物和骨桥蛋白（n=300）与CVD、CAC和CMR的相关性，并调整了DKD和其他心脏代谢和血糖危险因素，包括HbA1c、连续血糖监测指标（n=102）和晚期糖基化终产物（n=200）。结果：只有32%的参与者患有DKD (eGFR 2)，但40%患有CVD。尽管具有良好的心脏代谢管理（平均血压为132/64 mmHg； LDL和hdl -胆固醇分别为2.10 mmol/l和1.69 mmol/l，中位HbA1c为54.1 mmol/mol[7.1%]），但参与者表现出较高的CAC负担（中位评分937），在患有和不患有DKD的患者之间没有差异（分别为1136和878）。在血糖指标中，HbA1c，而不是低血糖或血糖变异性，仍然与CVD相关（or 1.40）。结论/解释：长期1型糖尿病患者，没有DKD，但具有良好的心脏代谢管理，仍然具有冠状动脉粥样硬化的高负担。改善高血糖和减轻炎症，特别是骨桥蛋白，对长期1型糖尿病患者的心血管疾病管理具有潜在的重要意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetologia 医学-内分泌学与代谢

CiteScore

18.10

自引率

2.40%

发文量

193

审稿时长

1 months

期刊介绍： Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.