title: Progression of Electrocardiographic Abnormalities in Type 1 Diabetes During 16 Years of Follow-up: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study.
abstract: BACKGROUND
  The electrocardiogram (ECG) is an objective tool for cardiovascular disease (CVD) risk assessment.
  
  
  RESULTS
  We evaluated distribution of ECG abnormalities and risk factors for developing new abnormalities in 1314 patients with type 1 diabetes (T1D) from the Epidemiology of Diabetes Interventions and Complications (EDIC) study. Annual ECGs were centrally read. ECG abnormalities were classified as major and minor according to the Minnesota ECG Classification. At EDIC year 1 (baseline), 356 (27.1%) of the participants had at least 1 ECG abnormality (major or minor) whereas 26 (2%) had at least one major abnormality. During 16 years of follow-up, 1016 (77.3%) participants developed at least 1 new ECG abnormality (major or minor), whereas 172 (13.1%) developed at least 1 new major abnormality. Independent risk factors for developing new major ECG abnormalities were: age, current smoking, increased systolic blood pressure, and higher glycosylated hemoglobin (hazard ratio [HR] [95% CI]: 1.04 [1.02-1.06] per 1-year increase, 1.75 [1.22-2.53], 1.03 [1.01-1.05] per 1 mm Hg increase, and 1.16 [1.04-1.29] per 10% increase, respectively). Independent risk factors for developing any new ECG abnormalities (major or minor) were age and systolic blood pressure (HR [95% CI]: 1.02 [1.01-1.03] per 1-year increase and 1.01 [1.00-1.02] per 1 mm Hg increase, respectively).
  
  
  CONCLUSIONS
  New ECG abnormalities commonly occur in the course of T1D, consistent with the recognized increasing risk for CVD as patients age. Advanced age, increased systolic blood pressure, smoking, and higher HbA1c are independent risk factor for developing major ECG abnormalities, which underscores the importance of tight glucose control in T1D in addition to management of common CVD risk factors.
authors.affiliation: Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC Section on Cardiology, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC esoliman@wakehealth.edu.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: The Biostatistics Center, George Washington University, Rockville, MD.
authors.forename: Jye-Yu C
authors.initials: JY
authors.lastname: Backlund
authors.affiliation: The Biostatistics Center, George Washington University, Rockville, MD.
authors.forename: Ionut
authors.initials: I
authors.lastname: Bebu
authors.affiliation: Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Yabing
authors.initials: Y
authors.lastname: Li
authors.affiliation: Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Zhu-Ming
authors.initials: ZM
authors.lastname: Zhang
authors.affiliation: The Biostatistics Center, George Washington University, Rockville, MD.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cleary
authors.affiliation: The Biostatistics Center, George Washington University, Rockville, MD.
authors.forename: John M
authors.initials: JM
authors.lastname: Lachin
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015897:Comorbidity; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: The Epidemiology of Diabetes Interventions and Complications Study; electrocardiogram; type 1 diabetes