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DOI: 10.2337/db06-0653
© 2006 by the American Diabetes Association
The Effect of Intensive Glycemic Treatment on Coronary Artery Calcification in Type 1 Diabetic Participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study
1 Biostatistics Center, George Washington University, Rockville, Maryland
2 University of Pittsburgh, Pittsburgh, Pennsylvania
3 Case Western Reserve University, Cleveland, Ohio
4 University of California, Irvine, California
5 Harbor UCLA (University of California, Los Angeles) Medical Center, Torrance, California
6 University of Toronto, Toronto, Canada
7 Harvard Medical School, Boston, Massachusetts
Address correspondence to David M. Nathan MD, Diabetes Unit, Massachusetts General Hospital, 32 Fruit St., Boston, MA 02114-2698. E-mail: dnathan{at}partners.org. Reprint requests can be addressed to the DCCT/EDIC Research Group, Box NDIC/DCCT/EDIC, Bethesda, MD 20892
Abbreviations:
CAC, coronary artery calcification; CT, computed tomography; CVD, cardiovascular disease; DCCT, Diabetes Control and Complications Trial; EDIC, Epidemiology of Diabetes Interventions and Complications; IMT, intima-media thickness; ROC, receiver operating characteristics
The Epidemiology of Diabetes Interventions and Complications (EDIC) study, an observational follow-up of the Diabetes Control and Complications Trial (DCCT) type 1 diabetes cohort, measured coronary artery calcification (CAC), an index of atherosclerosis, with computed tomography (CT) in 1,205 EDIC patients at 
7–9 years after the end of the DCCT. We examined the influence of the 6.5 years of prior conventional versus intensive diabetes treatment during the DCCT, as well as the effects of cardiovascular disease risk factors, on CAC. The prevalences of CAC >0 and >200 Agatston units were 31.0 and 8.5%, respectively. Compared with the conventional treatment group, the intensive group had significantly lower geometric mean CAC scores and a lower prevalence of CAC >0 in the primary retinopathy prevention cohort, but not in the secondary intervention cohort, and a lower prevalence of CAC >200 in the combined cohorts. Waist-to-hip ratio, smoking, hypertension, and hypercholesterolemia, before or at the time of CT, were significantly associated with CAC in univariate and multivariate analyses. CAC was associated with mean HbA1c (A1C) levels before enrollment, during the DCCT, and during the EDIC study. Prior intensive diabetes treatment during the DCCT was associated with less atherosclerosis, largely because of reduced levels of A1C during the DCCT.
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