title: Nephropathy, but not retinopathy, is associated with the development of heart disease in Type 1 diabetes: a 12-year observation study of 462 patients.
abstract: OBJECTIVE
  To study the occurrence of heart disease and death in Type 1 diabetic patients and evaluate whether presence of microangiopathy, i.e. nephropathy and retinopathy, was associated with the outcome.
  
  
  METHODS
  A 12-year observation study of 462 Type 1 diabetic patients without a previous history of heart disease at baseline who were treated under routine care in a hospital out-patient clinic.
  
  
  RESULTS
  A total of 85 patients developed signs of heart disease, i.e. myocardial infarction (n = 41), angina (n = 23), and heart failure (n = 17) and 56 patients died. The mortality for patients without signs of heart disease during the observation period was 7.6% compared with 51% in patients with myocardial infarction (P < 0.001), 26% in patients with angina (P < 0.01) and 65% in patients with heart failure (P < 0.001). The relative risk for death was 9.0 (P < 0.001) and 2.5 (P < 0.05) times higher in patients with macroalbuminuria and microalbuminuria, respectively. The risk for cardiovascular death was 18.3 times (P < 0.001) higher in patients with macroalbuminuria compared with patients with normoalbuminuria. In patients with sight-threatening retinopathy, the relative risk for death was 7.0 times higher (P < 0.01) and the risk for coronary heart disease events 4.4 times higher (P < 0.05) compared with patients with no retinopathy. However, when retinopathy was adjusted for presence of macroalbuminuria, this association disappeared.
  
  
  CONCLUSIONS
  This study shows a high incidence of heart disease in patients with Type 1 diabetes. The worse prognosis was seen in patients with sight-threatening retinopathy and macroalbuminuria and microalbuminuria at baseline. Macroalbuminuria and microalbuminuria were independently associated with a high risk for heart disease and death while the association with sight-threatening retinopathy only occurred in the presence of nephropathy.
authors.affiliation: Department of Medicine, University Hospital, Lund, Sweden. Ole.Torffvit@med.lu.se
authors.forename: O
authors.initials: O
authors.lastname: Torffvit
authors.forename: M
authors.initials: M
authors.lastname: Lövestam-Adrian
authors.forename: E
authors.initials: E
authors.lastname: Agardh
authors.forename: C-D
authors.initials: CD
authors.lastname: Agardh
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000209:etiology*; D003928:Diabetic Nephropathies / Q000150:complications*; D003930:Diabetic Retinopathy / Q000150:complications*; D005260:Female; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged