Silent Coronary Atheromatosis in Type 1 Diabetic Patients and Its Relation to Long-Term Glycemic Control
- Jakob Larsen1,
- Magne Brekke2,
- Leiv Sandvik3,
- Harald Arnesen4,
- Kristian F. Hanssen5 and
- Knut Dahl-Jorgensen1
- 1Diabetes Research Center/Department of Pediatrics, Ullevaal University Hospital, Oslo, Norway
- 2Department of Cardio-Vascular Radiology, Ullevaal University Hospital, Oslo, Norway
- 3Center for Clinical Research, Ullevaal University Hospital, Oslo, Norway
- 4Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
- 5Department of Endocrinology/Diabetes Research Center, Aker University Hospital, Oslo, Norway
Type 1 diabetic patients have a pronounced risk of premature coronary artery disease and death. We sought to evaluate the prevalence of silent coronary atheromatosis and to evaluate the relation between coronary atheromatosis and glycemic control. Coronary atheromatosis was evaluated in type 1 diabetic patients with no symptoms of coronary artery disease by exercise electrocardiogram (ECG) in 39 patients and quantitative coronary angiography and by intravascular ultrasound (IVUS) examinations in 29 patients. The findings from the IVUS examinations were related to mean HbA1c collected prospectively over 18 years. Abnormal exercise ECGs were found in 15% of patients, and angiographic diameter stenosis of >50% in one or more of the main coronary arteries was found in 34% of patients. All patients examined with intracoronary ultrasound had developed atherosclerotic plaques with an increased intimal thickness (>0.5 mm) in one or more of the coronary arteries. Coronary artery plaque formation, as judged by ultrasound, was significantly related to mean HbA1c during 18 years (P < 0.05) after adjustment for total cholesterol and age. This study demonstrates a high prevalence of silent coronary atheromatosis in type 1 diabetic patients with no symptoms of coronary heart disease. Long-term glycemic control was shown to be associated with coronary atheromatosis.
Address correspondence and reprint requests to Dr. Jakob Larsen, Department of Pediatrics, Ullevaal University Hospital, 0407 Oslo, Norway. E-mail:.
Received for publication 7 December 2001 and accepted in revised form 8 May 2002.
ECG, electrocardiogram; IVUS, intravascular ultrasound.