greater progression of coronary artery calcification is associated with clinically relevant cognitive impairment in type 1 diabetes background and aims we assessed the predictive role of coronary artery calcification cac in clinically relevant cognitive impairment in 148 middleaged individuals with childhoodonset type 1 diabetes t1d from the pittsburgh epidemiology of diabetes complications edc studymethods baseline cac was measured in 199698 and repeated 48 years later per extensive neuropsychological testing in 201015 28 41148 of participants met the study definition of clinically relevant cognitive impairment two or more of 7 select test scores 15sd worse than demographically appropriate published norms logistic regression models with backward selection were constructed for statistical analysisresults mean age and t1d duration at first cac measure were 37 and 29 years respectively a greater burden of initial cac was associated with cognitive impairment determined 14 years later compared to agatston score0 odds ratio or and 95 confidence intervals ci of 0300 were 14 06 36 23 06 97 and 79 16 385 respectively with both initial and progression of cac in the multivariable model backward selection retained only cac progression showing it was significantly associated with cognitive impairment or 95 ci 17 11 29 in those with an initial cac0 cac density was marginally inversely associated with cognitive impairment when controlling for cac volume or 95ci 03 01 12 p value0078conclusions greater cac burden was associated with clinically relevant cognitive impairment in middleaged adults with childhoodonset t1d cac progression appears to be a more powerful predictor than initial calcification