Lipid and blood pressure treatment goals for type 1 diabetes - 10-year incidence data from the Pittsburgh Epidemiology of Diabetes Complications Study

OBJECTIVE - Subjects with type 1 diabetes are at high risk for many long-te rm complications, including early mortality and coronary artery disease (CA D). Few data are available on which to base goal levels for two major risk factors, namely blood pressure and lipid/lipoproteins. The objective of thi s study was to determine at which levels of LDL and HDL cholesterol, trigly cerides, and blood pressure the relative risks of type 1 diabetic complicat ions increase significantly. RESEARCH DESIGN AND METHODS - Observational prospective study of 589 patien ts with childhood-onset type 1 diabetes (<17 years) aged <greater than or e qual to>18 years at baseline; 10-year incidence of mortality, CAD, lower-ex tremity arterial disease, proliferative retinopathy, distal symmetric polyn europathy, and overt nephropathy. Relative risks were determined using trad itional groupings of blood pressure and lipid/lipoproteins, measured at bas eline, using the lowest groupings (<100 mg/dl [2.5 mmol/l] LDL cholesterol, <45 mg/dl [1.1 mmol/l] HDL cholesterol, <100 mg/dl [1.1 mmol/l] triglyceri des, <110 mmHg systolic blood pressure, and <80 mmHg diastolic blood pressu re) as reference. Adjustments for age, sex, and glycemic control were exami ned. RESULTS - Driven mainly by strong relationships (RR range 1.8-12.1) with mo rtality, CAD, and overt nephropathy, suggested goal levels are as follows: LDL cholesterol <100 mg/dl (2.6 mmol/l), HDL cholesterol >45 mg/dl (1.1 mmo l/l), triglycerides <150 mg/dl(1.7 mmol/l), systolic blood pressure <120 mm Hg, and diastolic blood pressure <80 mmHg. Age, sex, and glycemic control h ad little influence on these goals. CONCLUSIONS - Although observational in nature, these data strongly support the case for vigorous control of lipid levels and blood pressure in patien ts with type 1 diabetes.