986-P: Evaluation of Cardiovascular Risk and All-Cause Mortality in Type 1 Diabetes: Comparison of Risk Engines in a 10-Year Follow-up

Abstract

Type 1 diabetes (T1D) has higher risk of death and CVD compared with general population. Effective risk stratification is essential to implement preventive strategies. We compare the performance of Steno Type 1 Risk Engine (ST1RE) and EURODIAB PCS Risk Engine (EURO-RE) in 733 T1D (M 52%; age 39.3±11.1; DD 18.5±11.6; A1c 7.8±1.2%) with no prior CVD over a 11-yr follow-up (IQR: 9.9-13.0). Both models include age, A1c and albuminuria; ST1RE includes 7 more variables (sex, DD, SBP, LDL-C, eGFR, smoking and exercise), EURO-RE only 2 more variables (WHR, HDL-C). By ST1RE, 453 T1D (61.8%) had low- (<10%), 179 (24.4%) moderate- (10-20%) and 101 (13.8%) high-risk (≥20%); for EURO-RE, estimates were 496 (67.7%), 161 (22.0%) and 76 (10.4%). Regression between 10-yr risks was 0.921 (p<0.0001); concordance of risk strata attribution was 82.5% (n = 605); 98 (13.4%); 30 (4.1%) T1D had higher and, respectively, lower risk by ST1RE vs. EURO-RE. C-statistic for all-cause death (n = 46) was 0.810 (95% CI 0.738-0.882) for ST1RE and 0.802 (0.729-0.875) for EURO-RE. Incidence of CVD was available for 697 T1D (95%). C-statistics for all CVD (n = 32) were 0.770 (0.699-0.841) and 0.777 (0.706-0.849) for ST1RE and EURO-RE, respectively; for coronary events (n = 23) 0.739 (0.650-0.828) and 0.765 (0.683-0.847); for coronary revascularization (n = 14) 0.802 (0.707-0.897) and 0.824 (0.742-0.905). With the limitation of low number of events, C-statistics for stroke (n = 8) were 0.764 (0.596-0.931) and 0.805 (0.654-0.955) for ST1RE and EURO-RE; for peripheral disease (n = 5) 0.794 (0.658-0.931) and 0.733 (0.518-0.948); for ESRD (n = 8) 0.719 (0.544-0.893) and 0.723 (0.529-0.917). Cox regression with backward variable processing selects EURO-RE as covariate for CVD and all other vascular events including ESRD, with ST1RE selected as the strongest covariate for all-cause death. Both ST1RE and the less-demanding EURO-RE are validated and widely available tools to identify high risk T1D individuals. Disclosure M. Garofolo: Consultant; Self; Eli Lilly and Company. E. Gualdani: None. D. Lucchesi: None. P. Falcetta: None. P. Francesconi: None. S. Del prato: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk, Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Speaker’s Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Sanofi. G. Penno: Advisory Panel; Self; Eli Lilly and Company.