OBJECTIVE The Diabetes Control and Complications Trial (DCCT) and its observational follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) demonstrated the dominant role of glycemia, second only to age, as a risk factor for a first cardiovascular event in type 1 diabetes (T1D). We now investigate the association between established risk factors and the total cardiovascular disease (CVD) burden, including subsequent (i.e., recurrent) events. RESEARCH DESIGN AND METHODS CVD events in the 1,441 DCCT/EDIC participants were analyzed separately by type (CVD death, acute myocardial infarction [MI], stroke, silent MI, angina, percutaneous transluminal coronary angioplasty/coronary artery bypass graft [PTCA/CABG], and congestive heart failure [CHF]) or as composite outcomes (CVD or major adverse cardiovascular events [MACE]). Proportional rate models and conditional models assessed associations between risk factors and CVD outcomes. RESULTS Over a median follow-up of 29 years, 239 participants had 421 CVD events, and 120 individuals had 149 MACE. Age was the strongest risk factor for acute MI, silent MI, stroke, and PTCA/CABG, while glycemia was the strongest risk factor for CVD death, CHF, and angina, second strongest for acute MI and PTCA/CABG, third strongest for stroke, and not associated with silent MI. HbA1c was the strongest modifiable risk factor for a first CVD event (CVD: HR 1.38 [95% CI 1.21, 1.56] per 1% higher HbA1c; MACE: HR 1.54 [1.30, 1.82]) and also for subsequent CVD events (CVD: incidence ratio [IR] 1.28 [95% CI 1.09, 1.51]; MACE: IR 1.89 [1.36, 2.61]). CONCLUSIONS Intensive glycemic management is recommended to lower the risk of initial CVD events in T1D. After a first event, optimal glycemic control may reduce the risk of recurrent CVD events and should be maintained.

中文翻译：

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1 型糖尿病中首次和后续 CVD 事件的风险因素：DCCT/EDIC 研究。

目的 糖尿病控制和并发症试验 (DCCT) 及其观察性随访糖尿病干预和并发症流行病学 (EDIC) 证明了血糖作为 1 型糖尿病首次心血管事件的危险因素，仅次于年龄。 (T1D)。我们现在调查已确定的风险因素与总心血管疾病 (CVD) 负担之间的关联，包括后续（即复发性）事件。研究设计和方法 1,441 名 DCCT/EDIC 参与者的 CVD 事件按类型（CVD 死亡、急性心肌梗死 [MI]、中风、无症状心肌梗死、心绞痛、经皮冠状动脉腔内成形术/冠状动脉旁路移植术 [PTCA/CABG]和充血性心力衰竭 [CHF]）或作为复合结果（CVD 或主要不良心血管事件 [MACE]）。比例率模型和条件模型评估了风险因素与 CVD 结果之间的关联。结果 在 29 年的中位随访期间，239 名参与者发生了 421 次 CVD 事件，120 人发生了 149 次 MACE。年龄是急性心肌梗死、无症状心肌梗死、中风和 PTCA/CABG 的最强危险因素，而血糖是 CVD 死亡、CHF 和心绞痛的最强危险因素，急性心肌梗死和 PTCA/CABG 的第二强危险因素，中风第三强的危险因素，并且与静默 MI 无关。HbA1c 是首次 CVD 事件（CVD：HR 1.38 [95% CI 1.21, 1.56] 每升高 1% HbA1c；MACE：HR 1.54 [1.30, 1.82]）和随后的 CVD 事件（CVD：发病率 [IR] 1.28 [95% CI 1.09, 1.51]；MACE：IR 1.89 [1.36, 2.61]）。结论 建议强化血糖管理以降低 T1D 患者初始 CVD 事件的风险。首次事件后，最佳血糖控制可降低 CVD 事件复发的风险，应予以维持。