BACKGROUND Microvascular complications (MC) have been claimed to increase the risk for cardiovascular disease in diabetic subjects. However, the effect of MC burden on the risk of major vascular outcomes and all-cause mortality in type 1 diabetes is still poorly explored. We evaluated the relationship between microvascular complications burden and incidence of major cardiovascular events and all-cause mortality in subjects with type 1 diabetes. METHODS We recruited 774 participants with type 1 diabetes in a single-center observational study over a follow-up of 10.8 ± 2.5 years. Hazard ratios (HR) for cardiovascular outcomes and all-cause death associated with microvascular complications were determined by unadjusted and adjusted Cox regression analysis. RESULTS Out of 774 individuals, 54.9% had no-MC, 32.3% 1 MC, 9.7% 2 MC and 3.1% 3 MC. A total of 54 deaths (7.0%) occurred. Death rate increased from no-MC 2.1% (Ref) to 1 MC 7.2% (HR 3.54 [95% CI 1.59-7.87]), 2 MC 14.7% (HR 6.41 [95% CI 2.65-15.49]) and 3 MC 66.7% (HR 41.73 [95% CI 18.42-94.57], p < 0.0001). After adjustments, HRs were: 1 MC 2.05 (95% CI 0.88-4.76), 2 MC 1.98 (95% CI 0.75-5.21), 3 MC 7.02 (95% CI 2.44-20.20, p = 0.002). Forty-nine subjects (6.7%) had at least one cardiovascular event, and cumulative incidence went from no-MC 2.2% (Ref) to 1 MC 5.0%; (HR 2.27 [95% CI 0.96-5.38]), 2 MC 26.8% (HR 12.88 [95% CI 5.82-28.50]) and 3 MC 40.9% (HR 29.34 [95% CI 11.59-74.25], p < 0.0001). Upon adjustments, HRs were: 1 MC 1.59 (95% CI 0.65-3.88), 2 MC 4.33 (95% CI 1.75-10.74), 3 MC 9.31 (95% CI 3.18-27.25, p < 0.0001). Thirty-five individuals (4.8%) had at least one coronary event, which cumulative incidence increased with MC burden (p < 0.0001). CONCLUSIONS In type 1 diabetes, microvascular complications burden increases in an independent dose-dependent manner the risk of major cardiovascular outcomes and all-cause mortality. The presence and number of microvascular complications should be considered in stratifying overall cardiovascular risk in type 1 diabetes.

中文翻译：

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微血管并发症负担（肾病、视网膜病和周围多发性神经病）影响 1 型糖尿病主要血管事件和全因死亡率的风险：一项 10 年随访研究。


背景技术已声称微血管并发症(MC)会增加糖尿病受试者患心血管疾病的风险。然而，MC 负担对 1 型糖尿病主要血管结局和全因死亡率风险的影响仍鲜有研究。我们评估了 1 型糖尿病患者的微血管并发症负担与主要心血管事件发生率和全因死亡率之间的关系。方法 我们招募了 774 名患有 1 型糖尿病的参与者进行一项单中心观察性研究，随访时间为 10.8 ± 2.5 年。通过未调整和调整的 Cox 回归分析确定心血管结局和与微血管并发症相关的全因死亡的风险比 (HR)。结果 在 774 名个体中，54.9% 没有 MC，32.3% 有 1 MC，9.7% 有 2 MC，3.1% 有 3 MC。共有 54 人死亡（7.0%）。死亡率从无 MC 2.1%（参考文献）增加至 1 MC 7.2%（HR 3.54 [95% CI 1.59-7.87]）、2 MC 14.7%（HR 6.41 [95% CI 2.65-15.49]）和 3 MC 66.7 %（HR 41.73 [95% CI 18.42-94.57]，p < 0.0001）。调整后，HR 为：1 MC 2.05 (95% CI 0.88-4.76)、2 MC 1.98 (95% CI 0.75-5.21)、3 MC 7.02 (95% CI 2.44-20.20，p = 0.002)。 49 名受试者 (6.7%) 至少发生过一次心血管事件，累积发生率从无 MC 2.2%（参考文献）升至 1 MC 5.0%； (HR 2.27 [95% CI 0.96-5.38])，2 MC 26.8% (HR 12.88 [95% CI 5.82-28.50]) 和 3 MC 40.9% (HR 29.34 [95% CI 11.59-74.25]，p < 0.0001 ）。调整后，HR 为：1 MC 1.59 (95% CI 0.65-3.88)、2 MC 4.33 (95% CI 1.75-10.74)、3 MC 9.31 (95% CI 3.18-27.25，p < 0.0001)。 35 人 (4.8%) 至少发生过一次冠状动脉事件，其累积发生率随着 MC 负担的增加而增加 (p < 0.0001)。 结论 在 1 型糖尿病中，微血管并发症负担以独立的剂量依赖性方式增加主要心血管结局和全因死亡率的风险。在对 1 型糖尿病的总体心血管风险进行分层时，应考虑微血管并发症的存在和数量。