Risk Factors for Coronary Heart Disease in Type 1 Diabetic Patients in Europe

Risk Factors for Coronary Heart Disease in Type 1 Diabetic Patients in Europe The EURODIAB Prospective Complications Study Sabita S. Soedamah-Muthu , PHD 1 , Nish Chaturvedi , MD 2 , Monika Toeller , MD 3 , Barry Ferriss , MD 4 , Paolo Reboldi , MD 5 , Georges Michel , MD 6 , Christos Manes , MD 7 , John H. Fuller , FRCP 1 and the EURODIAB Prospective Complications Study Group 1 Department of Epidemiology and Public-Health, Royal Free and University College London Medical School, London, U.K 2 International Centre for Circulatory Health and Department of Epidemiology and Public-Health, Imperial College London, London, U.K 3 Diabetes Research Institute, Heinrich-Heine University, Dusseldorf, Germany 4 Cork Regional Hospital, Cork, Ireland 5 Dipartimento di Medicina Interna e Scienze, Endocrine e Metaboliche, Perugia, Italy 6 Centre Hospitalier, Luxembourg, Luxemburg 7 General Hospital of Thessaloniki, Thessaloniki, Greece Address correspondence and reprint requests to Sabita S. Soedamah-Muthu, EURODIAB Department of Epidemiology and Public-Health Royal Free and University College London Medical School 1-19 Torrington Place, London, WC1E 6BT U.K.. E-mail: sabita{at}public-health.ucl.ac.uk Abstract OBJECTIVE —The goal of the study was to examine risk factors in the prediction of coronary heart disease (CHD) and differences in men and women in the EURODIAB Prospective Complications Study. RESEARCH DESIGN AND METHODS —Baseline risk factors and CHD at follow-up were assessed in 2,329 type 1 diabetic patients without prior CHD. CHD was defined as physician-diagnosed myocardial infarction, angina pectoris, coronary artery bypass graft surgery, and/or Minnesota-coded ischemic electrocardiograms or fatal CHD. RESULTS —There were 151 patients who developed CHD, and the 7-year incidence rate was 8.0 (per 1,000 person-years) in men and 10.2 in women. After adjustment for age and/or duration of diabetes, the following risk factors were related to CHD in men: age, GHb, waist-to-hip ratio (WHR), HDL cholesterol, smoking, albumin excretion rate (AER), and autonomic neuropathy. The following risk factors were related to CHD in women: age, systolic blood pressure (BP), fasting triglycerides, AER, and retinopathy. Multivariate standardized Cox proportional hazards models showed that age (hazard ratio 1.5), AER (1.3 in men and 1.6 in women), WHR (1.3 in men), smoking (1.5 in men), fasting triglycerides (1.3 in women) or HDL cholesterol (0.74 in women), and systolic BP (1.3 in