Evaluation of Cardiovascular Risk in People with Type 1 Diabetes: A Comprehensive and Specific Proposed Practical
Clara Viñals1, Ignacio Conget2,3,4, Montse Granados2
1Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Villarroel 170, 08036, Barcelona, Spain. vinals@clinic.cat.
Insights
Individuals with type 1 diabetes face higher cardiovascular disease (CVD) risks. This study proposes a practical approach to evaluate, classify, and manage CVD risk, emphasizing personalized care and specific interventions for better outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Diabetology
Background:
- Type 1 diabetes (T1D) significantly increases cardiovascular disease (CVD) risk, the primary cause of death in this population.
- Current CVD risk assessment in T1D often extrapolates from type 2 diabetes (T2D), despite differing underlying mechanisms of atherosclerosis.
- Established methods for microvascular complication assessment in T1D do not adequately address CVD comorbidities and risks.
Purpose of the Study:
- To propose a practical framework for evaluating, classifying, and managing cardiovascular disease risk specifically in individuals with type 1 diabetes.
- To highlight the limitations of current CVD risk assessment strategies in T1D and the need for T1D-specific approaches.
- To provide guidance on integrating advanced risk stratification tools and management strategies for CVD in T1D.
Main Methods:
- Review and synthesis of existing literature and clinical guidelines for CVD risk in T1D.
- Inclusion of specific risk stratification tools like the Steno Type 1 Risk Engine.
- Recommendations for diagnostic modalities such as carotid ultrasound for risk stratification.
- Outline of management cornerstones including diet, glycemic control, blood pressure, and lipid targets.
Main Results:
- Cardiovascular risk in T1D is multifactorial and requires tailored assessment beyond general diabetes guidelines.
- Carotid ultrasound and specific risk engines (e.g., Steno Type 1 Risk Engine) aid in accurate CVD risk stratification.
- Management involves Mediterranean diet, strict glycemic control (HbA1c < 7%), controlled blood pressure (<130/80 mmHg), and individualized LDL cholesterol targets.
- Antithrombotic therapy is indicated for secondary prevention, significant stenosis, or impaired ankle-brachial index.
Conclusions:
- A personalized and proactive approach is crucial for managing cardiovascular risk in type 1 diabetes.
- Regular, individualized medical follow-up (2-3 visits/year) and periodic carotid ultrasound are recommended.
- Specific interventions targeting modifiable risk factors are essential for reducing CVD morbidity and mortality in T1D patients.
Abstract:
People living with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD), and it is the leading cause of morbidity and mortality in this population. CVD risk increases with each uncontrolled risk factor, even in individuals with good glycaemic control. Recommendations for assessing CVD risk in the T1D population are extended from those for type 2 diabetes (T2D) even though the physiopathology and underlying mechanisms of atherosclerosis in T1D are poorly understood and differ from those in T2D. Unlike the assessment of microvascular complications, which is well established in T1D, this is far from being the case for the comorbidities and risk associated with CVD. Aside from classical cardiovascular comorbidities, carotid ultrasound can be useful to stratify CVD risk. The utilization of specific risk scales such as the Steno Type 1 Risk Engine can help to more accurately classify cardiovascular risk in these individuals. The cornerstones of the management of cardiovascular risk in T1D are the promotion of the Mediterranean diet, tight glycaemic control (glycated haemoglobin (HbA1c) < 7%), blood pressure < 130/80 mmHg in most patients, and low-density lipoprotein (LDL) cholesterol < 100 mg/dL in moderate-risk individuals, < 70 mg/dL in high-risk individuals, and < 55 mg/dL in very high-risk individuals. Conventional medical follow-up of patients with T1D should be individualized (approximately 2-3 visits per year), and a carotid ultrasound evaluation is recommended every 5 years in the absence of significant preclinical atherosclerosis or more often in those with severe preclinical atherosclerosis. Antithrombotic therapy is recommended in those receiving secondary prevention, those with stenosis > 50% in any arterial bed, and those with an impaired ankle-brachial index. This document is a proposal of a practical approach for the evaluation, classification, and management of CVD risk in individuals living with T1D.
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