7/10/2023 0 Comments Steno type 1 risk engineHyperglycaemia appears to have a more profound effect on cardiovascular risk in T1DM than T2DM. Development of T1DM before 10 years of age is associated with a 30-fold increased risk of CVD in early adulthood women with onset of T1DM before 10 years of age have a 90-fold increased risk of acute myocardial infarction over the same period. ![]() Age appears to be by far the most significant factor, followed by time-weighted mean HbA1c. The Steno Type 1 Risk Engine for the prediction of a first cardiovascular event in T1DM includes ten risk factors: age, sex, diabetes duration and HbA1c, systolic BP, low-density lipoprotein (LDL) cholesterol, glomerular filtration rate and albuminuria, and smoking and exercise. In an analysis of the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study baseline glycated haemoglobin (HbA1c), duration of diabetes, lower insulin doses, impaired renal function, increased albumin excretion, higher diastolic BP and lipid profile were all predictive of CVD. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. It is important that clinicians recognise that men and women with T1DM now have a similar absolute risk of CVD. In contrast to the general population therefore, female sex should not be considered to offer protection against CVD. The excess relative risk in women with T1DM is not explained by changes in known cardiovascular risk factors. This relative risk was previously reported as being 3.6 in men and 7.7 in women. Improved management of traditional cardiovascular risk factors has led to remarkable improvements in survival, with a 29% reduction in the relative risk of death over a 10-year period, such that the overall relative risk for CVD is now 2.3 for men and 3.0 for women. A similar approach in T1DM seems entirely reasonable. The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recently updated their position statement on the management of type 2 diabetes (T2DM) in adults, to include additional focus on cardiovascular risk factor management. While features such as the presence of nephropathy or retinopathy identify higher risk groups, the use of other biomarkers of risk and indeed the indication for enhanced treatment is often not appreciated. A standardized mortality ratio of up to 39-fold has been reported in patients with T1DM and significant renal disease. Īlthough the correlation between diabetes and CVD is well established, the underlying mechanisms remain poorly understood.Įarly studies of cardiovascular mortality in T1DM suggested that risk only significantly increases after the development of nephropathy, which coincides with a marked deterioration of the lipid profile and blood pressure (BP). ![]() By the age of 45 years, more than 70% of men and 50% of women with T1DM have developed coronary artery calcification (CAC). Recent data from Sweden show up to a tenfold elevated risk of cardiovascular mortality in T1DM according to glycaemic control, and up to an eightfold increase in risk at various ages, compared with the general population. The incidence of CVD is approximately 1–2% per year even among young adults with T1DM. Importantly the relative risk does not appear to be related to disease duration. A recent meta-analysis estimated the standardized mortality ratio attributable to cardiovascular disease (CVD) to be 5.7 for men and 11.3 for women with T1DM. Premature atherosclerosis is the main driver of this excess mortality for both men and women, with cardiovascular events occurring more than a decade earlier. Type 1 diabetes mellitus (T1DM) is associated with an almost threefold higher mortality than the general population.
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