Type A behavior and risk of all-cause mortality, CAD, and CAD-related mortality, in a type 1 diabetes population: 22 years of follow-up in the Pittsburgh Epidemiology of Diabetes Complications Study

Objective To determine whether type A behavior predicts all cause mortality and incident coronary artery disease (CAD) in a type 1 diabetes population. Research Design and Methods Twenty-two year follow-up data from the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood onset type 1 diabetes were analyzed for the 506 participants who completed the Bortner Rating Scale (measuring type A myocardial infarction as determined by hospital records/ Q waves on ECG, CAD death behavior) and Beck’s Depression Inventory (BDI) at baseline (1986-1988). CAD comprised (determined by a mortality classification committee), angiographic stenosis, ischemic ECG and angina. Results There were 128 deaths (25.3%) during follow-up. Univariate analysis showed an inverse relationship between Bortner scores and all cause mortality (p=0.01) which remained significant after allowing for age, sex, duration, HbA1c, education, smoking, BMI, and physical activity (p=0.03). However, the addition of BDI scores attenuated the relationship (p=0.11) with a significant interaction (p=0.03) such that any protective effect against mortality was limited among individuals with lower BDI scores (bottom 3 quintiles) (p=0.07), while no effect was seen in those with higher BDI (p=0.97). Bortner scores showed only a borderline association with incident CAD (p=0.09). Conclusions Those with higher type A behavior have lower all-cause mortality in our type 1 diabetes population, an effect that interacts with depressive symptomatology such that it is only operative in those with low BDI scores. Further research should focus on understanding this interaction