title: Low prevalence of subclinical atherosclerosis in asymptomatic patients with type 1 diabetes in a European Mediterranean population.
abstract: OBJECTIVE
  To evaluate the presence of early carotid and coronary atherosclerosis in asymptomatic patients with type 1 diabetes with no history of ischemic heart disease.
  
  
  METHODS
  One hundred and fifty patients with type 1 diabetes (58% males; 38.6 ± 8.1 years, 20.4 ± 8.1 years of evolution; HbA1c 8.1 ± 2.3%; 52% nonsmokers; 26% retinopathy; 9% microalbuminuria) and 50 nondiabetic control subjects age and sex matched were studied. Carotid ultrasonography to determine common carotid artery intima-media thickness (c-IMT) and the presence of atheroma plaques and cardiac computed tomography for calcium analysis and quantification (coronary artery calcium score [CACS]) were performed.
  
  
  RESULTS
  Most patients with type 1 diabetes and control subjects displayed a CACS of 0 (82 vs. 92%). Patients with type 1 diabetes with CACS ≥1 were older and had higher HbA1c (44.5 ± 5.1 vs. 36.7 ± 8.1 years [P < 0.001] and 8.5 ± 1.1 vs. 7.8 ± 1.0% [P < 0.003], respectively) and longer evolution of diabetes (25.4 ± 9.2 vs. 19.3 ± 7.4 years, P < 0.005) and mean c-IMT (0.67 ± 0.18 vs. 0.53 ± 0.11 mm, P < 0.001) compared with patients with CACS of 0. Smoking (P < 0.02), nephropathy (P < 0.05), retinopathy (P < 0.05), and male sex (P < 0.03) were significantly and positively associated with CACS ≥1. Mean c-IMT was significantly higher in patients with type 1 diabetes (0.55 ± 0.14 vs. 0.48 ± 0.14 mm, P < 0.01), and 11% of them presented atheroma plaques (8% of control subjects). Multivariant logistic regression analysis showed that c-IMT was related to CACS (β = 6.87, P < 0.001).
  
  
  CONCLUSIONS
  A small percentage of patients with type 1 diabetes showed data suggestive of subclinical atherosclerosis. Universal screening of coronary disease in this population is not justified. Carotid ultrasonography may be useful for screening in the subset of patients with cardiovascular risk factors and long disease evolution.
authors.affiliation: Endocrinology and Nutrition Unit, Department of Medicine, Institute of Research and Hospital Universitari Germans Trias i Pujol, Universitat Aut `onoma de Barcelona, Badalona, Spain. aguilerahurtado@yahoo.es.
authors.forename: Eva
authors.initials: E
authors.lastname: Aguilera
authors.forename: Enric
authors.initials: E
authors.lastname: Serra-Planas
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Granada
authors.forename: Núria
authors.initials: N
authors.lastname: Alonso
authors.forename: Silvia
authors.initials: S
authors.lastname: Pellitero
authors.forename: Eduarda
authors.initials: E
authors.lastname: Pizarro
authors.forename: Jordi Lluís
authors.initials: JL
authors.lastname: Reverter
authors.forename: Isabel
authors.initials: I
authors.lastname: Salinas
authors.forename: Berta
authors.initials: B
authors.lastname: Soldevila
authors.forename: Dídac
authors.initials: D
authors.lastname: Mauricio
authors.forename: Manel
authors.initials: M
authors.lastname: Puig-Domingo
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000150:complications / Q000453:epidemiology; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011859:Radiography; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult