Low BP & HbA1c protective against incident CVD in Type 1 DM Patients: EURODIAB Study

The American Heart Association (AHA) published criteria for ideal cardiovascular health, identifying seven metrics: smoking, BMI, physical activity, diet, total cholesterol, BP and fasting plasma glucose. Previous studies have examined ideal cardiovascular health in people with type 1 diabetes, but the criteria and the thresholds used have not always been the same as those used by the AHA. Therefore, Dr Soraya Soulimane and her team conducted a study to examine CVD risk reduction in type 1 diabetes (1) for people with favourable cardiovascular health metrics and (2) by clustering these metrics.

In this study, the researchers analyzed data from 2313 participants from the EURODIAB Prospective Complications Study. They evaluated seven cardiovascular health metrics such as smoking, BMI, physical activity, a diet score, total cholesterol/HDL-cholesterol ratio, combined systolic and diastolic BP and HbA1c—divided into favourable/less favourable categories. They used Cox proportional hazards models to calculate HRs (95% CIs) of incident CVD for each metric. They developed clusters by scoring each individual by the number of favourable metrics.

Key findings of the study:

• During follow-up of 7.2 ± 1.3 years, the researchers observed that 163 people developed incident CVD.
• They found that participants with more favourable HbA1c levels of <57 mmol/mol (<7.4%) had a 37% significantly lower CVD risk than those with a less favourable HbA1c (HR 0.63).
• They also found that participants with a more favourable BP (systolic BP <112 mmHg and diastolic BP <70 mmHg) had a 44% significantly lower CVD risk than participants in the less favourable BP group (HR 0.56).
• They observed that there was a dose-response relation with a lower HR and with greater clustering of more favourable metrics. They noted that people with four or more favourable metrics had an HR of 0.37, adjusted for sex and age at diabetes diagnosis, compared with those with no favourable metrics.

The authors concluded, "Low values of HbA1c and BP were protective against incident CVD and targeting a higher number of favourable cardiovascular health metrics that include lifestyle factors could significantly reduce the risk of CVD in type 1 diabetes. Further studies should investigate which clusters of factors are important in promoting cardiovascular health."

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DOI: https://doi.org/10.1007/s00125-022-05698-2