Evaluation of Cardiovascular Risk in Patients with Type 1 Diabetes: How Ankle Brachial Index Can Be Usefull?

Abstract

Background: Patients with type 1 diabetes (T1D) face a significantly higher mortality risk compared to the general population, primarily due to elevated rates of cardiovascular disease (CVD). Detecting cardiovascular disease at its preclinical stage is essential for effective primary prevention in this relatively young population. This study aims to assess the link between steno-risk and subclinical atherosclerotic disease, as detected by the Ankle-Brachial Index (ABI), in T1D patients and determine the prevalence of these abnormalities among them. Methods: A cohort of 312 adults with T1D (151 males and 161 females, mean age 31 ± 12 years) was examined. Patients were categorized based on their ABI values (ABI < 0.9 indicating peripheral arterial disease (PAD), ABI ≥ 1.3 indicating arterial calcification (AC), and ABI between 0.9 and 1.3 indicating normal ABI). The study analyzed the relationship between ABI anomalies and cardiovascular risk factors and their association with the steno-risk category. Results: Among the patients, 138 (44.2%) had a normal ABI, 112 (35.9%) had PAD, and 62 (19.9%) had AC. AC was more prevalent in men than in women (p = 0.006). A family history of stroke was common in both the PAD and AC groups (p = 0.042 and p = 0.046, respectively). Patients with AC were often older (36 ± 13 vs. 30 ± 12; P = .012), had a longer duration of diabetes (20 ± 11 vs. 14 ± 9; P < 0.001), a higher prevalence of hypertension (25.8% vs. 14.5%, P = 0.05), and a higher prevalence of smoking (19.3% vs. 9.4%, P = 0.046). A higher number of subjects with AC were found in the Steno-Risk 10–20% and Steno-Risk ≥20% categories compared to the Steno-Risk < 10% (37.5 vs. 15.5; 29 vs. 15.5, p = 0.0106, respectively). Conclusion: This study demonstrates that an ABI > 1.30 is more common in older patients with type 1 diabetes and is associated with a longer duration of diabetes, male gender, smoking, hypertension, and a family history of stroke. Furthermore, an ABI > 1.30, indicating arterial calcification, is significantly linked to moderate and high cardiovascular risk assessed by steno-risk in patients with type 1 diabetes. The ABI may serve as a straightforward tool for screening atherosclerosis in T1D.