Adherence to Modified American Heart Association Cardiovascular Health Standards Is Associated With Lower Atherosclerotic Burden in Mediterranean Individuals With Type 1 Diabetes

Abstract

Objectives

Cardiovascular risk factor (CVRF) management and healthy lifestyles protect against cardiovascular disease (CVD), although their impact in type 1 diabetes (T1D) is underexplored. This study aimed to examine the relationship between healthy lifestyle parameters and preclinical atherosclerosis in this population.

Materials and Methods

Cross-sectional study in individuals with T1D without established CVD, meeting one of the following: ≥ 40 years-old, diabetic kidney disease, or ≥ 10 years duration of T1D with another CVRF. We used a modification of the American Heart Association ‘Life's Simple Seven’ (AHA-LSS) scoring system, measuring 7 variables (body mass index, smoking, physical activity, Mediterranean diet, LDL-cholesterol, blood pressure, and HbA1c) scoring ranging 0–13 points (higher score, better CVRF profile). Presence of plaques was assessed using carotid ultrasound. Patients were categorised into low (AHA-LSS ≤ 5), medium (AHA-LSS 6–7) and high (AHA-LSS ≥ 8) tertiles. Associations between AHA score and atherosclerosis were assessed using logistic regression models.

Results

We included n = 518 individuals (55% women, age 48 ± 11 years, T1D duration 27 ± 11 years, HbA1c 7.49 ± 0.90%, AHA-LLS 6 [5–8]). An inverse relationship was observed between AHA-LSS score and different CVRFs and plaque burden (p < 0.05 for all). This inverse relationship persisted after adjusting for classical and specific-T1D CVRFs not included in the score, both for plaque presence (OR 0.37 [0.20–0.70]) and ≥ 2 plaques (OR 0.30 [0.13–0.68]; p < 0.05).

Conclusions

Holistic control of CVRFs and healthy lifestyles are associated with lower preclinical atherosclerosis prevalence in individuals with T1D. These findings highlight the need to address non-glycaemic factors in this population to improve cardiovascular health.