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
- Patricia A. Cleary1,
- Trevor J. Orchard2,
- Saul Genuth3,
- Nathan D. Wong4,
- Robert Detrano5,
- Jye-Yu C. Backlund1,
- Bernard Zinman6,
- Alan Jacobson7,
- Wanjie Sun1,
- John M. Lachin1,
- David M. Nathan7 and
- for the DCCT/EDIC Research Group*
- 1Biostatistics Center, George Washington University, Rockville, Maryland
- 2University of Pittsburgh, Pittsburgh, Pennsylvania
- 3Case Western Reserve University, Cleveland, Ohio
- 4University of California, Irvine, California
- 5Harbor UCLA (University of California, Los Angeles) Medical Center, Torrance, California
- 6University of Toronto, Toronto, Canada
- 7Harvard 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
Abstract
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.
- 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
Footnotes
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* A complete list of individuals and institutions participating in the DCCT/EDIC Research Group appears in the appendix.
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The Writing Group of the DCCT/EDIC Research Group takes responsibility for the contents of this article.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Accepted August 23, 2006.
- Received May 11, 2006.
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