HIGH MORTALITY FROM UNIDENTIFIED CVD IN IDDM - TIME TO START SCREENING

Mortality in insulin-dependent diabetes is markedly increased compared to the general population. Although strong associations have been fou nd between renal disease and the risk of cardiovascular disease (CVD) the interaction between these two factors is not well understood. This study, which addresses risk factors for mortality in IDDM with a part icular focus on the renal-CVD link, is based on the prospective Epidem iology of Diabetes Complications study. Thirty-seven (mean age 36 year s, mean duration of IDDM 28 years at baseline) of the 658 IDDM individ uals (mean age 28 years, mean duration of IDDM 20 years at baseline) h ave died in the first 4 years of follow up. A nested case-control stud y was performed, matching on sex and duration of diabetes. Twenty-two (59%) of the deaths were attributed to coronary heart disease, with an additional 16% attributed to diabetic coma. Only nine (41%) of the 22 individuals who died from cardiovascular disease had clinical evidenc e of coronary heart disease when seen for their last biennial exam. Ho wever, 54% of those who died of CVD without prior evidence did have ev idence of lower extremity arterial disease. A strong link with renal d isease was confirmed, with 81% of those with a coronary artery disease death having renal disease. Multivariate analyses suggest that smokin g history, triglycerides and total platelet count are independent pred ictors of mortality, while LDL cholesterol best predicted CVD mortalit y. These results suggest a need for more intensive screening for cardi ovascular disease, and correction of cardiovascular risk factors, in o rder to reduce the increased rate of mortality in this population. Eff orts to prevent or delay the onset of renal disease may also be of ben efit.