NHLBI Working Group
Cardiovascular Complications of Type 1 Diabetes:
Identifying New Opportunities for Prevention and Treatment

Executive Summary

The National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the Juvenile Diabetes Research Foundation (JDRF) convened a Working Group of investigators on April 27-28, 2003, in Bethesda, Maryland. The purpose of this meeting was to identify ways to close the gaps in our knowledge about the development of cardiovascular (CV) complications in Type 1 diabetic patients and to identify opportunities for future studies to elucidate the causes and improve treatments for this major chronic complications in middle-aged Type 1 diabetic patients. The two major objectives for this meeting were: 1) to evaluate opportunities for studies to answer fundamental questions about the pathogenesis of CV complications among patients with type 1 diabetes and 2) to evaluate opportunities for intervention studies to reduce CV complications among patients with Type 1 diabetes.

The following recommendations in priority order were made to the NHLBI, NIDDK, and JDRF:

1. Support mechanistic studies involving the vascular wall, endothelial dysfunction, and the role of inflammation and the immune system in the onset and progression of cardiovascular complications in Type 1 diabetes.
2. In existing Type 1 diabetes cohorts, support clinical ancillary studies related to cardiovascular complications such as the role of inflammatory cytokines, adhesion molecules and molecular and inflammatory mediators.
3. Encourage the validation of newly developed functional and molecular imaging techniques that could be utilized in Type 1 diabetes to document development and progression of subclinical and clinical cardiovascular disease.
4. Expand our understanding of the natural history and progression of cardiovascular disease in Type 1 diabetes, focusing on the development of reliable biomarkers of CVD. Large clinical trial data bases, such as the Epidemiology of Diabetes Interventions and Complications (EDIC) trial may be particularly useful.
5. Using biomarkers and imaging techniques to measure CVD outcomes, encourage pilot clinical trials to identify new therapies and interventions to address CVD in Type 1 diabetes.
6. Support data analyses and evaluate outcomes relevant to cardiovascular disease form the Epidemiology of Diabetes Interventions and Complications (EDIC) trial.

Working Group Members

Co-Chairs:

• Peter Libby, M.D., Brigham and Women's Hospital, Department of Medicine, Boston
• David Nathan, MD, Director, General Clinical Research Center, Director, MGH Diabetes Center, Boston

Members:

• Robert Balaban, MD, NIH-NHLBI, Bethesda
• John D. Brunzell, MD, Department of Medical Metabolism, University of Washington, Seattle
• Jeffrey Carr, MD, Dept. of Radiology and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem
• Antonio Ceriello, Department of Pathology and Medicine, Clinical and Experimental Chair, Internal Medicine, University of Udine, Udine, Italy
• Allan Collins, MD, Department of Medicine, Nephrology Analytic Service, Minneapolis Medical Research Foundation, Minneapolis
• Timothy Garvey, MD, Medical University of South Carolina, Division of Endocrinology, Medicine/Diabetes and Medical Genetics, Charleston
• Steven M. Haffner, MD, MPH, Department of Medicine and Epidemiology, University of Texas Health Science Center at San Antonio
• Willa Hsueh, MD, Department of Medicine and Endocrinology, University of California, Los Angeles
• Michael R. Jirousek, Ph.D., Pfizer Global Research and Development, LaJolla Laboratories, San Diego
• Bertram Kasiske, MD, Department of Medicine, Division of Renal/Dis/Hy, University of Minnesota, Minneapolis
• Susan Laing, Section of Epidemiology, The Institute of Cancer Research, London, UK
• Steven Nissen, MD, Medical Director, Cleveland Clinic Cardiovascular Coordinating Center, The Cleveland Clinic Foundation, Cleveland
• Trevor Orchard, Ph.D., University of Pittsburgh, Dept of Epidemiology, Pittsburgh
• Donald Orlic, Ph.D., Genetics and Molecular Biology Branch - NHGRI, Bethesda
• John R. Petrie, Ph.D., University of Glasgow, Department of Medicine and Therapeutics, Scotland, UK
• Marian Rewers, MD, Ph.D., University of Colorado, Department of Preventive Medicine/Biometric, Denver
• Neil Ruderman, MD, Boston Medical Center, Department of Medicine, Boston
• Anne Marie Schmidt, MD, Columbia University, Department of Surgery, New York