Long‐term predictors of coronary artery disease and mortality in type 1 diabetes

We assessed clinical and biochemical predictors of death and/or cardiovascular disease in 147 type 1 diabetes mellitus (DM) patients followed‐up for 14 years. At follow‐up, 28 of patients (19%) had died, and 25 patients (18%) had developed or died of coronary artery disease (CAD). At baseline, those who died had significantly higher serum creatinine ( p =0.001) and urine albumin/creatinine ratio ( p =0.016), greater prevalence of retinopathy ( p =0.006), lower serum apolipoprotein A1 ( p =0.046), and lower daily insulin dose ( p =0.024) than those who survived. CAD patients had a longer duration of diabetes ( p <0.001), were older at the onset of diabetes and at presentation ( p =0.001), and had higher prevalences of retinopathy ( p =0.005) and neuropathy ( p =0.016). The CAD group also had higher baseline serum creatinine ( p =0.02), lower HDL cholesterol ( p =0.004) and apolipoprotein A1 ( p =0.007) and higher LDL cholesterol ( p =0.028) and apolipoprotein B concentrations ( p =0.027). Under logistic regression analysis (adjusted for age and sex), baseline urine albumin/creatinine ratio ( p =0.003), presence of retinopathy ( p =0.004), serum creatinine ( p =0.028), and serum urea ( p =0.034) were the most powerful predictors of mortality, while duration of diabetes ( p <0.0001), baseline HDL cholesterol ( p =0.012), serum creatinine ( p =0.02), apolipoprotein B ( p =0.038), LDL cholesterol ( p =0.039), and systolic blood pressure ( p =0.055) were the strongest predictors of CAD. These findings emphasize the role of abnormal lipoprotein metabolism in the development of CAD in type 1 DM. Indicators of renal impairment and the presence of retinopathy seem to be of greater importance in predicting overall mortality.