Risk factors related to inflammation and endothelial dysfunction in the DCCT/EDIC cohort and their relationship with nephropathy and macrovascular complications.
OBJECTIVE
Because endothelial cell dysfunction and inflammation are key contributors to the development of complications in type 1 diabetes, we studied risk factors related to endothelial dysfunction and inflammation (C-reactive protein and fibrinogen, soluble vascular cell adhesion molecule-1, intracellular adhesion molecule-1, and E-selectin, and fibrinolytic markers) in a subgroup of patients from the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Intervention and Complications (EDIC) study cohort.


METHODS
We determined which of these risk factors or clusters thereof are associated with the presence of and subsequent development of nephropathy and macrovascular complications (reflected by carotid intima-media thickness [IMT]).


RESULTS
After adjustment for conventional risk factors (age, sex, DCCT treatment group, diabetes duration, A1C, systolic blood pressure, waist-to-hip ratio, total and HDL cholesterol, and smoking status), fibrinogen remained strongly associated with progression of internal and common carotid IMT (P < 0.01) and soluble E-selectin had a strong association with nephropathy (P < 0.01).


CONCLUSIONS
The best predictor for IMT progression in the DCCT/EDIC cohort was plasma fibrinogen, and the levels of soluble E-selectin discriminate patients with albuminuria better than conventional risk factors.
Lopes-Virella
Maria F
MF
Department of Medicine and Laboratory Services, Medical University of South Carolina and Ralph H Johnson VA Medical Center, Charleston, South Carolina, USA. virellam@musc.edu
Carter
Rickey E
RE
Gilbert
Gregory E
GE
Klein
Richard L
RL
Jaffa
Miran
M
Jenkins
Alicia J
AJ
Lyons
Timothy J
TJ
Garvey
W Timothy
WT
Virella
Gabriel
G
D000328:Adult; D000419:Albuminuria / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002339:Carotid Arteries / Q000473:pathology; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000517:prevention & control; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000517:prevention & control; D004730:Endothelium, Vascular / Q000473:pathology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012044:Regression Analysis; D012307:Risk Factors; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology
D015415:Biomarkers; D002097:C-Reactive Protein