Burden and progression of arterial calcification in type 1 diabetes predicts future cardiovascular disease

Even in the absence of kidney disease in persons with type 1 diabetes, there is an increased risk of cardiovascular (CV) disease through mechanisms not fully understood. This study aims to investigate whether evaluating arterial calcification can augment CV risk stratification in people with type 1 diabetes.

Persons with type 1 diabetes included in previous studies evaluating subclinical CV disease with CT scans of arterial beds in 75 persons without kidney disease were assessed for major adverse CV events (MACE) defined as CV-death, ischemic heart disease, heart failure, stroke, coronary interventions, and/or peripheral artery intervention. CT allowed for evaluation of coronary artery calcium score (CACS), progression of coronary artery calcium and generalised arterial calcification in multiple arterial beds. Cox regression was used for survival analyses.

Seventy-three persons were available for endpoint evaluation and 16 (22 %) experienced a MACE after a median follow-up of 12.4 years (IQR 9.1-12.8). In unadjusted analyses, MACE was associated with baseline CACS > 10 (p = 0.003), progression of coronary artery calcium (p = 0.03) and generalised arterial calcification (p = 0.006). After adjustment for diabetes duration, baseline CACS > 10 remained associated with increased risk of MACE (p = 0.04).

This study shows that increased CACS entails increased risk of future MACE in persons with type 1 diabetes without kidney- or prior CV disease. This finding suggests that CACS evaluation may help differentiate CV risk management in persons with long-term type 1 diabetes without evidence of kidney disease and thus may be another step towards individualised medicine.