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Unseen threat: how subclinical atherosclerosis increases mortality risk in patients with type 1 diabetes
Lidia Sojo-Vega1,2, Mònica Recasens1, Joan Martínez2
1Department of Endocrinology, Diabetes Unit, University Hospital Dr, Josep Trueta of Girona, Av. França s/n, 17007, Girona, Spain.
Insights
Subclinical atherosclerosis is common in type 1 diabetes patients and significantly increases the risk of major cardiovascular events and death. Identifying predictors like male sex and diabetic nephropathy aids in personalized risk management.
Area of Science:
- Cardiology
- Endocrinology
- Diabetology
Background:
- Cardiovascular disease (CVD) is the leading cause of death in type 1 diabetes (T1D).
- Subclinical atherosclerosis detection can improve CVD risk stratification and personalize therapies in T1D.
- This study investigates subclinical atherosclerosis prevalence, predictors, and survival impact in T1D patients without overt CVD.
Purpose of the Study:
- To determine the prevalence and predictors of subclinical atherosclerosis in T1D patients.
- To assess the impact of subclinical atherosclerosis on patient survival over a minimum 5-year follow-up.
Main Methods:
- Observational study of 507 T1D patients (2015-2023) meeting specific age/duration criteria.
- Subclinical atherosclerosis assessed using carotid and femoral artery ultrasound.
- Survival analysis (Kaplan-Meier) monitored major adverse cardiovascular events (MACE) and all-cause mortality.
Main Results:
- Subclinical atherosclerosis found in 43% of patients.
- Predictors included male sex, diabetic nephropathy, tobacco use, higher HbA1c, older age, and longer diabetes duration.
- Subclinical atherosclerosis was linked to a significantly higher risk of MACE (HR 25.1) and death (OR 7.57).
Conclusions:
- Subclinical atherosclerosis is an independent predictor of mortality and MACE in T1D.
- Identifying clinical predictors is crucial for risk stratification and personalized prevention strategies.
- Early detection and management of subclinical atherosclerosis can improve outcomes for high-risk T1D patients.
Background:
Cardiovascular disease (CVD), particularly ischemic heart disease, remains the leading cause of death and morbidity in patients with type 1 diabetes. Detecting subclinical atherosclerosis could enhance cardiovascular risk stratification and enable individualised therapies. The aim of this study is to investigate the prevalence and predictors of subclinical atherosclerosis in patients with type 1 diabetes without overt cardiovascular disease (CVD) and to assess its impact on patient survival over a follow-up period of at least 5 years.
Methods:
This observational study included 507 patients treated at the Diabetes Unit of the Hospital of Girona Doctor Josep Trueta between 2015 and 2023. The inclusion criteria for patients were as follows: those aged 18 and older with diabetes for a minimum of 10 years or those aged 40 and older with a diabetes for at least 5 years. Subclinical atherosclerosis was identified via ultrasound imaging of the carotid and femoral arteries. Clinical and biochemical evaluations were also conducted. Major cardiovascular events (MACE) and deaths from other causes were monitored, and survival analysis was performed using Kaplan‒Meier methods.
Results:
Subclinical atherosclerosis was detected in 218 patients (43%). Multivariate analysis revealed that the male sex, diabetic nephropathy, tobacco exposure, higher HbA1c levels, older age, and longer diabetes duration were significant predictors. During a mean follow-up of 70.64 ± 27.08 months, 19 patients experienced MACE, and 13 died from any cause. The probability of MACE or death was greater in patients with subclinical atherosclerosis, with a hazard ratio (HR) of 25.1 (95% CI 5.81-108, p < 0.001) for MACE and an odds ratio (OR) of 7.57 (95% CI 1.97-53.9, p = 0.004) for death.
Conclusion:
Subclinical atherosclerosis is independently associated with increased overall mortality and MACE in patients with type 1 diabetes. Identifying clinical predictors can improve risk stratification and personalised therapeutic strategies to prevent MACEs in this high-risk population.
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