Abstract
Cardiovascular disease (CVD) is a major cause of mortality in type 1 diabetes mellitus (T1DM) patients, and cardiovascular risk (CVR) remains high even in T1DM patients with good metabolic control. The underlying mechanisms remain poorly understood and known risk factors seem to operate differently in T1DM and type 2 diabetes mellitus (T2DM) patients. However, evidence of cardiovascular risk assessment and management in T1DM patients often is extrapolated from studies on T2DM patients or the general population. In this review, we examine the existing literature about the prevalence of clinical and subclinical CVD, as well as current knowledge about potential risk factors involved in the development and progression of atherosclerosis in T1DM patients. We also discuss current approaches to the stratification and therapeutic management of CVR in T1DM patients. Chronic hyperglycemia plays an important role, but it is likely that other potential factors are involved in increased atherosclerosis and CVD in T1DM patients. Evidence on the estimation of 10-year and lifetime risk of CVD, as well as the efficiency and age at which current cardiovascular medications should be initiated in young T1DM patients, is very limited and clearly insufficient to establish evidence-based therapeutic approaches to CVD management.
Highlights
Published: 20 April 2021The prevalence of diagnosed type 1 diabetes (T1DM) among US adults in 2016 and 2017 was 0.5% [1] and is increasing worldwide, which may be partly related to reduced natural selection associated with health advances [2]
The main epidemiological studies demonstrate that cardiovascular disease (CVD) events are more common and occur earlier in type 1 diabetes mellitus (T1DM) patients than in the general population, CVD prevalence varies substantially depending on diabetes duration, age, and gender (Table 1)
Over the last years to values comparable to those of the general population [96,97,98]. This increase in the prevalence of obesity and metabolic syndrome could be related to intensive glycemic control issues corresponding with the DCCT study, which demonstrated that intensive therapy was correlated with excessive weight gain, impaired lipid profile, high blood pressure (HBP), obesity, insulin resistance, and inflammation [99]
Summary
The prevalence of diagnosed type 1 diabetes (T1DM) among US adults in 2016 and 2017 was 0.5% [1] and is increasing worldwide, which may be partly related to reduced natural selection associated with health advances [2]. Over the past few decades, reduction in cardiovascular mortality and coronary cardiovascular disease in non-diabetic and diabetic patients has corresponded with an overall mortality reduction and significant improvement in life expectancy in patients with type 2 (T2DM) and type 1 diabetes mellitus (T1DM) [3,4] These findings are reflected clearly in the two cohorts of the Pittsburgh Epidemiology of Diabetes Complication (EDC) Study, which found an increase of 14 years in life expectancy between T1DM patients diagnosed in 1950–1964 and those diagnosed in 1965–1980 [5,6]. This improvement seems to be related to the optimization of glycemic control, management of cardiovascular risk (CVR) factors, and interventional cardiology.
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