Background
The value of carotid-femoral pulse wave velocity (cfPWV) as a risk factor for complications remains to be determined in type 1 diabetes (T1D). We investigated the ability of cfPWV to predict all-cause mortality, cardiovascular events (CVE) and renal outcomes in persons with T1D.
Methods
CfPWV was measured using the SphygmoCor device in 633 persons with T1D. Median (interquartile range) follow-up was 6.2 (5.8−6.7) years and endpoints were traced through national registers and electronic medical records and included mortality, composite CVE, decline in eGFR ≥30%, progression in albuminuria group and ESRD. Hazard ratios (HR) were calculated per 1 standard derivation (SD) increase. Yearly change in eGFR and albuminuria were calculated for a median of 5.5 years. Adjustments included age, sex, HbA1c, mean arterial pressure, BMI, LDL-cholesterol, smoking, urine albumin excretion rate and eGFR.
Results
The cohort included 45% women, mean ± SD age was 54 ± 13 years and cfPWV 10.4 ± 3.3 m/s. After adjustment, higher cfPWV was associated with increased risk of mortality (n=48; HR:1.36; 95%CI 1.004−1.85); composite CVE (n=81; HR:1.31; 1.01−1.70); decline in eGFR ≥ 30% (n=90;HR: 1.38; 1.06−1.79) and progression in albuminuria (n=34; HR:1.59; 1.10−2.32), but not with ESRD (n=19; HR: 1.18; 0.62−2.26). Higher cfPWV was associated with a steeper decline in eGFR and a steeper increase in albuminuria after adjustment (p=0.013 and 0.002, respectively).
Conclusions
In this T1D cohort, cfPWV was consistently and independently associated with a higher risk of mortality, CVE, decline in renal function and progression in albuminuria. Measurement of cfPWV may have a promising role in risk stratification in T1D.