Glycemia and cardiovascular disease in type 1 diabetes mellitus.
OBJECTIVE
To evaluate the role of glycemic control in the development of cardiovascular disease (CVD) in type 1 diabetes mellitus (DM).


METHODS
We review the literature regarding coronary atherosclerosis, coronary artery calcification, and the epidemiologic studies related to the role of glycemia and the classic risk factors for coronary artery disease (CAD) in type 1 DM.


RESULTS
Four prospective studies (Wisconsin Epidemiologic Study of Diabetic Retinopathy, EURODIAB, Steno Diabetes Center Study of Adults With Type 1 DM, and Pittsburgh Epidemiology of Diabetes Complications study) do not show that glycemic control predicts CAD occurrence. Findings from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study show that compared with conventional insulin therapy, intensive insulin therapy reduces CVD among patients with type 1 DM and is associated with lower prevalence of coronary artery calcification. The discrepancies between the findings from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study and the Pittsburgh Epidemiology of Diabetes Complication study are likely due to differences between the study populations and the lower prevalence of renal disease in the former study. Besides duration of DM and albuminuria/overt nephropathy, insulin resistance is a major determinant of CAD associated with type 1 DM.


CONCLUSIONS
Discrepant study results regarding the relationship between glycemia and CAD/coronary artery calcification may be related to the prevalence of renal disease and the presence of the metabolic syndrome. Published data suggest that addressing traditional risk factors including albuminuria, the metabolic syndrome, and inflammatory markers is better for preventing and treating CAD than focusing exclusively on glycemic control, which is still necessary for preventing microvascular complications. Furthermore, there is a synergistic effect of glycemic control and albuminuria on the development of CVD.
Wajchenberg
Bernardo Léo
BL
Diabetes and Heart Center, Heart Institute, Hospital das Clinicas of the University of São Paulo Medical School, São Paulo, SP, Brazil. bernarwaj@globo.com
Feitosa
Alina Coutinho Rodrigues
AC
Rassi
Nelson
N
Lerário
Antonio Carlos
AC
Betti
Roberto Tadeu Barcelos
RT
D001786:Blood Glucose / Q000378:metabolism* / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control; D003324:Coronary Artery Disease / Q000209:etiology / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000378:metabolism*; D006801:Humans
D001786:Blood Glucose