Jingchuan Guo1, Maria M Brooks2, Matthew F Muldoon3, Ashely I Naimi2, Trevor J Orchard2, Tina Costacou2. 1. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA jig38@pitt.edu. 2. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA. 3. Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Abstract
OBJECTIVE: We aimed to determine optimal blood pressure (BP) thresholds for minimizing coronary artery disease (CAD) risk in people with childhood-onset type 1 diabetes. RESEARCH DESIGN AND METHODS: The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study participants without known CAD at baseline (n = 605) were included and followed for 25 years. The associations of time-weighted BP measures (systolic BP [SBP], diastolic BP [DBP], and mean arterial pressure) with incident CAD were examined by using Cox models. Areas under the receiver operating characteristic curve (AUC) were summarized by different cut points of time-weighted BPs. Risk stratification analyses were then performed on the basis of BP (<120/80 vs. ≥120/80 mmHg) and HbA1c (<8% vs. ≥8%). RESULTS: Baseline mean age was 27 years. Half of the cohort were women and 98% were white. A dose-gradient association was observed for categorized time-weighted BPs and CAD. According to AUC, the optimal cut point for SBP was 120 mmHg and for DBP was 80 mmHg. BP ≥120/80 mmHg was associated with a 1.9 times (95% CI 1.4, 2.6) greater risk of developing CAD than that for BP <120/80 mmHg. Participants with good control of both BP and HbA1c had BP <120/80 mmHg and HbA1c <8%. Those with only high BP (hazard ratio [HR] 2.0 [95% CI 1.1, 3.9]) carried a similar risk of developing CAD as those with only high HbA1c (HR 1.6 [95% CI 0.97, 2.8]). CONCLUSIONS: The optimal BP threshold associated with minimal CAD risk is 120/80 mmHg in young adults with childhood-onset type 1 diabetes.
OBJECTIVE: We aimed to determine optimal blood pressure (BP) thresholds for minimizing coronary artery disease (CAD) risk in people with childhood-onset type 1 diabetes. RESEARCH DESIGN AND METHODS: The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study participants without known CAD at baseline (n = 605) were included and followed for 25 years. The associations of time-weighted BP measures (systolic BP [SBP], diastolic BP [DBP], and mean arterial pressure) with incident CAD were examined by using Cox models. Areas under the receiver operating characteristic curve (AUC) were summarized by different cut points of time-weighted BPs. Risk stratification analyses were then performed on the basis of BP (<120/80 vs. ≥120/80 mmHg) and HbA1c (<8% vs. ≥8%). RESULTS: Baseline mean age was 27 years. Half of the cohort were women and 98% were white. A dose-gradient association was observed for categorized time-weighted BPs and CAD. According to AUC, the optimal cut point for SBP was 120 mmHg and for DBP was 80 mmHg. BP ≥120/80 mmHg was associated with a 1.9 times (95% CI 1.4, 2.6) greater risk of developing CAD than that for BP <120/80 mmHg. Participants with good control of both BP and HbA1c had BP <120/80 mmHg and HbA1c <8%. Those with only high BP (hazard ratio [HR] 2.0 [95% CI 1.1, 3.9]) carried a similar risk of developing CAD as those with only high HbA1c (HR 1.6 [95% CI 0.97, 2.8]). CONCLUSIONS: The optimal BP threshold associated with minimal CAD risk is 120/80 mmHg in young adults with childhood-onset type 1 diabetes.
Authors: John W McEvoy; Yuan Chen; Andreea Rawlings; Ron C Hoogeveen; Christie M Ballantyne; Roger S Blumenthal; Josef Coresh; Elizabeth Selvin Journal: J Am Coll Cardiol Date: 2016-08-30 Impact factor: 24.094
Authors: Stanley S Franklin; Sohum S Gokhale; Vincent H Chow; Martin G Larson; Daniel Levy; Ramachandran S Vasan; Gary F Mitchell; Nathan D Wong Journal: Hypertension Date: 2014-11-24 Impact factor: 10.190
Authors: Yong Ma; Marinella Temprosa; Sarah Fowler; Ronald J Prineas; Maria G Montez; Janet Brown-Friday; Mary L Carrion-Petersen; Tracy Whittington Journal: Am J Hypertens Date: 2008-12-04 Impact factor: 2.689
Authors: Rachel G Miller; Hemant D Mahajan; Tina Costacou; Akira Sekikawa; Stewart J Anderson; Trevor J Orchard Journal: Diabetes Care Date: 2016-09-21 Impact factor: 19.112
Authors: Debasish Banerjee; Peter Winocour; Tahseen A Chowdhury; Parijat De; Mona Wahba; Rosa Montero; Damian Fogarty; Andrew Frankel; Gabrielle Goldet; Janaka Karalliedde; Patrick B Mark; Dipesh Patel; Ana Pokrajac; Adnan Sharif; Sagen Zac-Varghese; Stephen Bain; Indranil Dasgupta Journal: Kidney Int Rep Date: 2022-01-13
Authors: D Banerjee; P Winocour; T A Chowdhury; P De; M Wahba; R Montero; D Fogarty; A H Frankel; J Karalliedde; P B Mark; D C Patel; A Pokrajac; A Sharif; S Zac-Varghese; S Bain; I Dasgupta Journal: BMC Nephrol Date: 2022-01-03 Impact factor: 2.388
Authors: Susan M Devaraj; Andrea M Kriska; Trevor J Orchard; Rachel G Miller; Tina Costacou Journal: Diabetologia Date: 2020-11-14 Impact factor: 10.122