Endocrine Abstracts

Mortality from cardiovascular disease in men and women with type 1 diabetes is 4 and 8 fold greater, respectively, than the general population. In addition, cardiovascular events and deaths occur at a relatively young age in type 1 diabetes, underlining the necessity to determine the most appropriate interventions for this vulnerable population. A number of recent trials have confirmed that long term maintenance of tight glycaemic control reduces cardiovascular event rates. However, this alone is not sufficient to reduce risk to general population levels. Epidemiological investigation demonstrates the importance of factors which make up the metabolic syndrome, including elevated blood pressure and dyslipidaemia in the aetiology of cardiovascular disease. It has also shown that the generally favourable lipid profile in type 1 diabetes is lost in the presence of diabetic nephropathy, offering a potential pathway for the close association between nephropathy and cardiovascular disease. Despite these observations, cardiovascular disease has not been well studied in type 1 diabetes, and clinical trials of interventions other than glucose lowering relatively limited. One of the main reasons for this is the relatively low absolute event rate, even though risks relative to the general population are high. Thus the importance of cardiovascular disease in type 1 diabetes is not fully appreciated. Further, the expense and logistic challenge of clinical trials, which would need to recruit large numbers for a long period of follow-up, in part at least, prohibit their conduct. The implications for management of people with type 1 diabetes to prevent cardiovascular disease are discussed, and views on the way forward offered.