Type 1 diabetes and cardiovascular medicine

There are an estimated 9.5 million people living with type 1 diabetes (T1D) globally, with cardiovascular disease (CVD) remaining a major cause of morbidity and mortality despite advances in care. Atherosclerosis occurs earlier in people with T1D and those with T1D-onset in early childhood are at particularly high lifetime risk of CVD. Multiple traditional risk factors (e.g., glycaemia, lipids, blood pressure, obesity and smoking) and novel risk factors (e.g., social determinants of health, inflammation and genetics) can promote CVD in people with T1D. This highlights the need for a life-course approach to managing overall cardiovascular risk and preventing or mitigating end-stage complications such as atherosclerotic events, cardiac autonomic neuropathy and heart failure. However, most people with T1D do not meet all recommended risk factor targets. Whilst T1D-specific risk calculators for CVD are available to guide shared decision-making and risk factor management, greater awareness and further data are needed to inform their use in different T1D populations. However, there remains a relative paucity of T1D-specific clinical trial data to inform the management and therapies for CVD risk factors such as dyslipidaemia, hypertension and chronic kidney disease (CKD), and for clinically evident CVD. There is now increasing interest in the use of adjunct glucose-lowering drugs initially developed for use in type 2 diabetes, such as sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 agonists, and whilst some weight, glycaemia, blood pressure and albuminuria benefits have been shown, cardiovascular outcome trials (CVOT) in T1D are currently lacking. This review by a multidisciplinary team provides an overview of CVD pathophysiology, risk factor care, risk prediction and management in people with T1D.