COMPARING THE CARDIOVASCULAR RISK ESTIMATION IN YOUNG ADULT PATIENTS WITH TYPE 1 DIABETES: STENO F1RISKENGINE VS. ESC-EASD 2019 RISK TABLE

Abstract

Objective: Adult patients with type 1 diabetes (T1DM) have very high cardiovascular risk, which is typically underestimated in daily clinical practice. The ESC-EASD risk table (2019) for both type 1 and type 2 diabetes is based on categorical variables, ignores specific variables such as HbA1c and yields an imprecise risk estimation (moderate, high or very high). The rarely used Steno T1RiskEngine predicts the 5-year and 10-year risks of a cardiovascular event and of terminal kidney disease, both absolute and relative to the reference population. We undertook to compare the results of both cardiovascular risk calculations in a group of young adult patients with T1DM. Design and method: Retrospective analysis of the data from consecutive patients with a sufficient collection of clinical data was performed. Informed consent was obtained from all patients. The ESC/EASD 2019 risk table is available at doi:10.1093/eurheartj/ehz486; the Steno T1RiskEngine is described in doi:10.1161/CIRCULATIONAHA.115018844 and the calculator is available online: (https://steno.shinyapps.io/T1RiskEngine1) Results: 30 patients were included, 18 women (60%), aged 32±9 years. According to the ESC/EASD table, 2 (6.7%) had moderate risk, 16 (53.3%) had high risk and 12 (40%) had very high risk. With the Steno T1RiskEngine the median risk of cardiovascular event was 6.4% (IQR 2.7-9.3%) at 5 years and 12.4% (IQR 5.9-17.6%) at 10 years, with medians of 1.7% and 3.4% in the reference population (relative risks 376% and 365% at 5 and 10 years); the median risk of terminal kidney disease was 2.9% (IQR 1.2-6.7%) vs. 0.8% in the reference population (relative risk 362%). By cardiovascular risk categories, with the Steno T1RiskEngine we obtained 3 patients (10%) with moderate risk, 13 (43.3%) with high risk and 14 (46.7%) with very high risk, without significant difference vs. the ESC/EASD categorization (Chi2 p = 0.72). Conclusions: The cardiovascular and renal risk of our adult patients with T1DM is very high (>3.5x the reference population risk); the ESC/EASD categorisation of cardiovascular risk does not significantly differ from that of the T1RiskEngine. However, the Steno T1RiskEngine yields a more precise estimation of the individual risks and should be used more frequently.