Abstract

BackgroundPatients with type 1 diabetes (T1D) have higher mortality risk compared to the general population; this is largely due to increased rates of cardiovascular disease (CVD). As accurate CVD risk stratification is essential for an appropriate preventive strategy, we aimed to evaluate the concordance between 2019 European Society of Cardiology (ESC) CVD risk classification and the 10-year CVD risk prediction according to the Steno Type 1 Risk Engine (ST1RE) in adults with T1D.MethodsA cohort of 575 adults with T1D (272F/303M, mean age 36 ± 12 years) were studied. Patients were stratified in different CVD risk categories according to ESC criteria and the 10-year CVD risk prediction was estimated with ST1RE within each category.ResultsMen had higher BMI, WC, SBP than women, while no difference was found in HbA1c levels between genders. According to the ESC classification, 92.5% of patients aged < 35 years and 100% of patients ≥ 35 years were at very high/high risk. Conversely, using ST1RE to predict the 10-year CVD risk within each ESC category, among patients at very high risk according to ESC, almost all (99%) had a moderate CVD risk according to ST1RE if age < 35 years; among patients aged ≥35 years, the majority (59.1%) was at moderate risk and only 12% had a predicted very high risk by ST1RE. The presence of target organ damage or three o more CV risk factors, or early onset T1D of long duration (> 20 years) alone identified few patients (< 30%) among those aged ≥35 years, who were at very high risk according to ESC, in whom this condition was confirmed by ST1RE; conversely, the coexistence of two or more of these criteria identified about half of the patients at high/very high risk also according to this predicting algorithm. When only patients aged ≥ 50 years were considered, there was greater concordance between ESC classification and ST1RE prediction, since as many as 78% of those at high/very high risk according to ESC were confirmed as such also by ST1RE.ConclusionsUsing ESC criteria, a large proportion (45%) of T1D patients without CVD are classified at very high CVD risk; however, among them, none of those < 35 years and only 12% of those ≥ 35 years could be confirmed at very high CVD risk by the ST1RE predicting algorithm. More studies are needed to characterize the clinical and metabolic features of T1D patients that identify those at very high CVD risk, in whom a very aggressive cardioprotective treatment would be justified.

Highlights

  • Patients with type 1 diabetes (T1D) have higher mortality risk compared to the general population; this is largely due to increased rates of cardiovascular disease (CVD)

  • Using European Society of Cardiology (ESC) criteria, a large proportion (45%) of T1D patients without CVD are classified at very high CVD risk; among them, none of those < 35 years and only 12% of those ≥ 35 years could be confirmed at very high CVD risk by the Steno Type 1 Risk Engine (ST1RE) predicting algorithm

  • The aim of the present study was to evaluate the concordance between 2019 ESC CVD risk classification and 10-year CVD risk predicted by ST1RE in a cohort of unselected T1D patients without previous CVD

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Summary

Introduction

Patients with type 1 diabetes (T1D) have higher mortality risk compared to the general population; this is largely due to increased rates of cardiovascular disease (CVD). Worldwide estimates of numbers of individuals with Type 1 diabetes (T1D) continue to increase [1] Among other reasons, this is worrisome since adults with T1D have an almost threefold higher mortality compared to the general population, largely due to premature cardiovascular disease (CVD) [2,3,4,5,6,7]. According to more recent data from the Swedish National Diabetes Register, patients with T1D and a glycated hemoglobin level of 6.9% or lower still have a twofold risk of death compared to matched controls [2] These findings, together with the evidence from randomized clinical trials (RCTs) [9] support the concept that, in addition to glycemic control, other factors concur to increase CVD incidence in these patients [9,10,11,12]. At present, the stratification of CVD risk in T1D patients is mainly based on observational data [10]

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