Avdic Tarik, Eliasson Björn, Rawshani Araz, Boren Jan, Gerstein Hertzel C, Nordanstig Joakim, Rihawi Mohamad, Beckman Joshua A, McGuire Darren K, Omerovic Elmir, Sattar Naveed, Bhatt Deepak L, Rawshani Aidin
Sahlgrenska Academy, Gothenburg, Sweden.
Department of Medicine, Sahlgrenska University Hospital Gothenburg, Sweden.
Lancet Reg Health Eur. 2024 Feb 15;39:100852. doi: 10.1016/j.lanepe.2024.100852. eCollection 2024 Apr.
Observational studies on long-term trends, risk factor association and importance are scarce for type 1 diabetes mellitus and peripheral arterial outcomes. We set out to investigate trends in non-coronary complications and their relationships with cardiovascular risk factors in persons with type 1 diabetes mellitus compared to matched controls.
34,263 persons with type 1 diabetes mellitus from the Swedish National Diabetes Register and 164,063 matched controls were included. Incidence rates of extracranial large artery disease, aortic aneurysm, aortic dissection, lower extremity artery disease, and diabetic foot syndrome were analyzed using standardized incidence rates and Cox regression.
Between 2001 and 2019, type 1 diabetes mellitus incidence rates per 100,000 person-years were as follows: extracranial large artery disease 296.5-84.3, aortic aneurysm 0-9.2, aortic dissection remained at 0, lower extremity artery disease 456.6-311.1, and diabetic foot disease 814.7-77.6. Persons with type 1 diabetes mellitus with cardiometabolic risk factors at target range did not exhibit excess risk of extracranial large artery disease [HR 0.83 (95% CI, 0.20-3.36)] or lower extremity artery disease [HR 0.94 (95% CI, 0.30-2.93)], compared to controls. Persons with type 1 diabetes with all risk factors at baseline, had substantially elevated risk for diabetic foot disease [HR 29.44 (95% CI, 3.83-226.04)], compared to persons with type 1 diabetes with no risk factors. Persons with type 1 diabetes mellitus continued to display a lower risk for aortic aneurysm, even with three cardiovascular risk factors at baseline [HR 0.31 (95% CI, 0.15-0.67)]. Relative importance analyses demonstrated that education, glycated hemoglobin (HbA1c), duration of diabetes and lipids explained 54% of extracranial large artery disease, while HbA1c, smoking and systolic blood pressure explained 50% of lower extremity artery disease and HbA1c alone contributed to 41% of diabetic foot disease. Income, duration of diabetes and body mass index explained 66% of the contribution to aortic aneurysm.
Peripheral arterial complications decreased in persons with type 1 diabetes mellitus, except for aortic aneurysm which remained low. Besides glycemic control, traditional cardiovascular risk factors were associated with incident outcomes. Risk of these outcomes increased with additional risk factors present. Persons with type 1 diabetes mellitus exhibited a lower risk of aortic aneurysm compared to controls, despite presence of cardiovascular risk factors.
Swedish Governmental and the county support of research and education of doctors, the Swedish Heart and Lung Foundation, Sweden and Åke-Wibergs grant.
关于1型糖尿病与外周动脉结局的长期趋势、危险因素关联及重要性的观察性研究较少。我们旨在调查1型糖尿病患者与匹配对照组相比，非冠状动脉并发症的趋势及其与心血管危险因素的关系。
纳入瑞典国家糖尿病登记处的34263例1型糖尿病患者和164063例匹配对照组。使用标准化发病率和Cox回归分析颅外大动脉疾病、主动脉瘤、主动脉夹层、下肢动脉疾病和糖尿病足综合征的发病率。
2001年至2019年期间，每10万人年的1型糖尿病发病率如下：颅外大动脉疾病296.5 - 84.3，主动脉瘤0 - 9.2，主动脉夹层保持为0，下肢动脉疾病456.6 - 311.1，糖尿病足疾病814.7 - 77.6。与对照组相比，心血管代谢危险因素处于目标范围的1型糖尿病患者未表现出颅外大动脉疾病[风险比（HR）0.83（95%置信区间，0.20 - 3.36）]或下肢动脉疾病[HR 0.94（95%置信区间，0.30 - 2.93）]的额外风险。与无危险因素的1型糖尿病患者相比，基线时所有危险因素均存在的1型糖尿病患者患糖尿病足疾病的风险大幅升高[HR 29.44（95%置信区间，3.83 - 226.04）]。即使基线时有三种心血管危险因素，1型糖尿病患者患主动脉瘤的风险仍然较低[HR 0.31（95%置信区间，0.15 - 0.67）]。相对重要性分析表明，教育程度、糖化血红蛋白（HbA1c）、糖尿病病程和血脂解释了颅外大动脉疾病的54%，而HbA1c、吸烟和收缩压解释了下肢动脉疾病的50%，仅HbA1c就导致了糖尿病足疾病的41%。收入、糖尿病病程和体重指数解释了主动脉瘤贡献的66%。
1型糖尿病患者外周动脉并发症有所减少，但主动脉瘤除外，其发病率仍然较低。除血糖控制外，传统心血管危险因素与发病结局相关。这些结局的风险随着额外危险因素的存在而增加。与对照组相比，1型糖尿病患者即使存在心血管危险因素，患主动脉瘤的风险也较低。
瑞典政府及县对医生研究和教育的支持、瑞典心肺基金会、瑞典和阿克 - 维伯格基金。
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