CORONARY ARTERY CALCIFICATION IN TYPE I DIABETES

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Coronary artery disease (CAD) is the main cause of death in person with Type I diabetes. CAD also occurs earlier in life, affects women as often as men, and associated mortality is dramatically higher than that in the general population. This study will focus on non-invasive detection of CAD in high-risk persons with Type I diabetes for application in future screening and prevention programs. A sample of 800 patients with Type I diabetes and 600 non-diabetic controls will be recruited from the Denver Metro Area. The population distribution approximates the national and Denver area demographics for Type I diabetes. This study will recruit approximately 49% male and 51% female subjects; the expected ethnic distribution is 87% white, 7% Hispanic, 3% black, and 3% other. To enroll in the study, all subjects must be between 20 and 55 years of age. Patients with type I diabetes must have had diabetes for at least 10 years, must have been diagnosed before the age of 30, and must have had insulin within one year of being diagnosed. Both diabetic and non-diabetic patients will come for an initial clinic visit. At this visit, patients will be asked about their medical background. Measurements of weight, height, waist and hip circumference, and blood pressure will be taken. An electrocardiogram (ECG), a urine sample and blood sample will also be obtained. Diabetic patients will be asked to come in for another clinic visit in 3-years. Patients will also be scheduled for an electron-beam computed tomography scan (EBCT), which will look for coronary artery calcification in the heart. A scan of the abdomen will be done at the same time to measure the amount of fat in the abdomen. A coronary artery calcification (CAC) score and left ventricular area (LV area) will be calculated. CAC and large LV area may be early signs of CAD. All patients will be asked to have a repeat EBCT in 3 years. In a substudy, 50 high-risk diabetics (CAC score about 100), 30 low-risk diabetics (CAC score below 100), and 20 controls will come in for an additional visit. This visit will consist of a rest/stress test, which looks at heart blood flow at rest and during maximal exercise (using a treadmill). A contrast dye will be used in both cases to determine the blood flow in the heart. Patients with diabetes will be asked to repeat the rest/stress test in 3-years.