Pitt Public Health Findings Suggest Improved Way to Determine Heart Disease Risk in Type 1 Diabetes

Physicians caring for people with type 1 diabetes might be better able to determine their patients’ chances of developing heart disease if they include their levels of protective antioxidants in the assessment, according to a new study from the University of Pittsburgh Graduate School of Public Health.

The study, funded by the National Institutes of Health (NIH), was published today in the November issue of the journal Diabetes Care. It relied on data from “Pittsburgh Epidemiology of Diabetes Complications,” a historical prospective investigation of childhood onset type 1 diabetes cases diagnosed, or seen within one year of diagnosis, at Children’s Hospital of Pittsburgh (now part of UPMC) between 1950 and 1980.

“Currently in clinical practice, physicians assess a patient’s risk factors for developing a disease to determine what, if any, preventative measures to take,” said lead author Tina Costacou, Ph.D., assistant professor of epidemiology at Pitt Public Health. “In our study, we found that the risk of people with type 1 diabetes developing heart disease is better predicted by looking at the ratio of factors representing protection – for example, antioxidants – to those representing harm – for example oxidative stress levels. Currently, doctors most commonly determine heart disease risk by looking at the level of harmful risk factors alone, which may not give an accurate picture of the person’s risk.”

In a statistical analysis over time, it appeared that patients with higher levels of oxidative stress (measured with a urine test) who also had higher levels of a form of the antioxidant vitamin E (measured with a blood test) had a lower risk of developing heart disease compared to those with higher levels of oxidative stress and lower levels of protective antioxidants.

Thus, although both patient groups had higher levels of oxidative stress, they were actually at a different risk of developing heart disease, and only those with the lower levels of antioxidants may need additional treatment to try to prevent heart disease from developing.

“This improved way of determining risk is not necessarily limited to the hypothesis of oxidative stress and antioxidants in terms of heart disease development; it could be expanded to other risk/protective factors and other pathologic conditions. If further supportive data are published, it may one day become possible to better classify a person’s disease risk and individualize treatment based on simultaneous assessment of risk and protective factors,” said Dr. Costacou.

Additional co-authors on this study include Trevor J. Orchard, M.B.B.Ch., M.Med.Sci., Robert W. Evans, Ph.D., and Gerald L. Schafer, M.S., all of Pitt Public Health’s Department of Epidemiology.

This research was supported by NIH grants DK34818 and DK082900.


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