How to improve cardiovascular risk assessment in type 1 diabetes? The role of vascular age and arterial stiffness.

Abstract

Introduction: Cardiovascular disease is the leading cause of mortality in individuals with type 1 diabetes mellitus (T1DM). Traditional cardiovascular risk (CVR) models may underestimate risk in this population, especially in high-risk countries. Vascular age (VA) and arterial stiffness (AS) are emerging as potential markers for improving CVR assessment.

Objectives: This study investigated the association between VA, AS, and the modified Steno Type 1 Risk Engine (ST1RE) score in adults with T1DM.

Patients and methods: We included 109 T1DM adults, aged 18-50 years, with at least five years of disease duration. None had been diagnosed with cardiovascular disease or hypertension. VA was calculated using carotid intima-media thickness (cIMT), while AS was assessed by 24-hour measurement of aortic pulse wave velocity (PWV). We compared the standard ST1RE score, based on chronological age, with a modified ST1RE score based on VA.

Results: Study participants had a median age of 32.4 (25.5-38.6) years and a diabetes duration of 14.0 (10.0-20.0) years. Using VA in the modified ST1RE score reclassified 32.1% of participants into a higher CVR category. The median CVR for the modified ST1RE was 9.68 (4.61-20.08)%, compared to 4.74 (3.24-8.12)% using the standard score. The modified ST1RE score was positively associated with PWV, OR 2.37 (95% CI: 1.46-3.84) p = 0.004, adjusting for sex, BMI, and at least one diabetic complication.

Conclusions: Implementing VA and AS in clinical practice could enhance risk assessment in T1DM individuals, especially in high-risk populations. Further validation in larger cohorts is necessary.