Preclinical carotid atherosclerosis is independently associated with cardiovascular events and mortality in type 1 diabetes.

Abstract

Background: To evaluate whether carotid atherosclerosis predicts future cardiovascular events (CVE) and mortality in adults with type 1 diabetes (T1D) in primary prevention.

Methods: Cohort study in adults with T1D participating in a cardiovascular risk assessment program that included carotid ultrasound. Eligibility criteria included age ≥ 40 years, diabetic kidney disease regardless of age or diabetes duration, or type 1 diabetes duration ≥ 10 years in the presence of at least one additional cardiovascular risk factor.The primary endpoint was the first CVE. A secondary endpoint was a composite of CVE plus all-cause mortality. Carotid plaque burden and outcomes were analyzed using Kaplan-Meier curves and Cox regression models.

Results: 701 individuals were followed for a mean of 5.85 years (mean age 48.5 years; T1D duration 27 years; 51.9% males). Carotid plaques were identified in 40.4%. During follow-up, 45 CVE occurred (18 coronary artery disease, 14 peripheral artery disease, 6 stroke, 3 heart failure, 4 deaths) along with 5 non-cardiovascular deaths. Event-free survival declined progressively with increasing plaque burden (log-rank p < 0.001). In unadjusted analyses, the presence of any plaque was associated with increased risk of CVE (HR 3.14, 95%C I 1.69-5.84) and of the composite endpoint (HR 3.07, 95% CI 1.71-5.51). After multivariable adjustment for demographic, metabolic, and microvascular factors, a high plaque burden (≥ 3 plaques) remained associated with CVE (HR 3.38, 95% CI 1.37-8.38) and with the composite endpoint (HR 2.64, 95% CI 1.13-6.21).

Conclusions: Preclinical carotid atherosclerosis in adults with T1D was independently associated with an increased risk of cardiovascular events and mortality. These findings support the potential role of carotid ultrasound as a complementary tool for cardiovascular risk assessment in individuals with T1D.