Relative Importance of CVD Risk Factors in Type 1 Diabetes Males and Females

Introduction and Objective: Hormonal, genetic, and physiological differences often affect disease manifestation, progression, and treatment response. Modification of relationships of triglycerides (TRG) or insulin resistance reflected as TRG to HDL ratio (Ratio) by HbA1c (or pulse) and of severe hypoglycemia history (SH) by retinopathy status with CVD were reported. Therefore, we assessed relative CVD risk factor importance including relevant interactions in a male and a female T1D cohort. Methods: NIDDK Central Repository available DCCT/EDIC data of 1441 generally healthy T1D volunteers at baseline (mean age ~27 years, 680 females) were analyzed. Volunteers were followed for ~30 years. Time dependent multivariable COX regression was performed. CVD events (CVE) included acute/silent myocardial infarct, cardiac death, confirmed angina, and revascularization. Aike criteria was used to compare models. Results: Of 761 males, 88 and of 680 females, 80 reported a CVE. In models without interactions, most important CVD factors for males were age, stroke/congestive heart failure history, mean (M) pulse, M insulin dose, TRG, and M HbA1c [hazard ratio (HR):1.09 p<0.0001; 3.84 p<0.01; 1.04 p<0.05; 3.27 p<0.05; 2.55 p<0.05; 1.21 p<0.05]. Replacing TRG with Ratio gave similar results. For females, M HbA1c, M systolic blood pressure, age, LDL, SH, and diabetes duration [HR:1.44 p<0.0001; 1.05, p<0.001; 1.07 p<0.001; 1.01 p<0.01; 1.85 p<0.05, 1.005 p<0.05, respectively] were most important factors. For males, interaction (retinopathy*SH) was next to age the most important CVD risk factor (p<0.0001). Neither M pulse nor M HbA1c affected associations of TRG or Ratio with CVD.In females, associations of TRG or Ratio (separate models) with CVD were significantly affected by M HbA1c (p<0.01, both) or M pulse (p<0.001, both). P value for interaction (SH*retinopathy) was 0.06. Conclusion: Our novel findings provide new valuable insights into the role of potential CVD risk factors in males and females and warrant further investigation to be better able to identify high risk T1D individuals. Disclosure: E.R. Fahrmann: None. H. Driscoll: None. Funding: A special big thank you to the DCCT/EDIC investigators for their generosity and making their data publicly accessible. The authors extend another special thank you to the NIDDK Central Repositories. The DCCT and its follow-up, the Epidemiology of Diabetes Interventions and Complications (EDIC) study, were conducted by the DCCT/EDIC Research Group and supported by National Institute of Health grants and contracts and by the General Clinical Research Center Program, National Center for Research Resources. The data from the DCCT/EDIC study were supplied by the NIDDK Central Repositories. This manuscript was not prepared under the auspices of the DCCT/EDIC study and does not represent analyses or conclusions of the DCCT/EDIC study group, the NIDDK Central Repositories, or the National Institutes of Health.