PULSE WAVE ANALYSIS IN TYPE 1 DIABETES:RELATIONSHIP WITH HISTORICAL MEASURES AND PREVALENT DISEASE

Type 1 diabetes (T1D) is associated with numerous complications. These include renal and cardiovascular disease which are the leading causes of morbidity and mortality in T1D. Renal complications also increase the risk for cardiovascular disease. Early detection and treatment of their risk factors may help to prevent or at least delay these complications. This dissertation examines potential risk factors for altered measures of pulse wave analysis (PWA), which have been linked to cardiovascular events and mortality in other populations. It also examines how PWA measures relate to prevalent cardiovascular and renal complications in T1D.Prospective analyses of potential risk factors for increased arterial stiffness indices, augmentation index (AIx) and augmentation pressure (AP), and decreased estimated myocardial perfusion, i.e. subendocardial viability ratio (SEVR), showed autonomic neuropathy, smoking history, low HDL cholesterol and poorer glycemic control, to be associated with altered PWA measures 18 years later.Next, cross-sectional analyses between PWA measures and prevalent CVD showed AP and SEVR to be significantly related to coronary artery disease and coronary artery calcification, respectively, although age was the major predictor of both. AP was also higher, although not significantly, and SEVR significantly lower in those with peripheral vascular disease.Finally, SEVR, but not AIx nor AP, was significantly associated with the presence of microalbuminuria (MA), and preferentially entered multivariate models over brachial blood pressure measures. SEVR was also related to degree of albuminuria in those within the normo- and MA range, and was significantly associated, multivariately, with low renal function.This dissertation thus yields significant Public Health findings by identifying factors (AN, smoking, glycemic control, lipid levels) that may delay increased arterial stiffness (AIx and AP) and decreased myocardial perfusion (SEVR). As it additionally shows that these same PWA measures are altered in the presence of CVD and renal damage in T1D a potential role for PWA measures, especially SEVR, in risk stratification and early intervention for T1D complications is apparent