Arterial stiffness in patients with type 1 diabetes and its comparison to cardiovascular risk evaluation tools

Abstract

Background Arterial stiffness is a potential biomarker for cardiovascular disease (CVD) risk in patients with type 1 diabetes (T1D). However, its relation with other CV risk evaluation tools in T1D has not been elucidated yet. This study aimed to evaluate arterial stiffness in T1D patients free from known CVD, and compare it to other CV risk evaluation tools used in T1D. Methods Cross-sectional study in adults with a T1D duration of at least 10 years and without established CVD. Patients were categorized in CVD risk groups based on 2019 European Society of Cardiology (ESC) guidelines, and the STENO T1D risk engine was used to estimate 10-year risk for CV events. Arterial stiffness was evaluated with carotid-femoral pulse wave velocity (cf-PWV). Coronary artery calcium (CAC) score was assessed and carotid ultrasound was performed. Ambulatory 24-h blood pressure and central hemodynamic parameters were evaluated. Data on renal function and diabetic kidney disease was retrieved. Results 54 patients (age: 46 ± 9.5 years; T1D duration: 27 ± 8.8 years) were included. One-fourth of patients showed prematurely increased aortic stiffness based on cf-PWV (24%). Cf-PWV was significantly associated with CAC score, carotid intima-media thickness, central hemodynamic parameters and diabetic kidney disease. Based on STENO, 20 patients (37%) were at low, 20 patients (37%) at moderate, and 14 patients (26%) at high 10-year risk for CV event. Cf-PWV was strongly associated with the STENO score (rs = + 0.81; R2 = 0.566, p < 0.001), increasing with each higher STENO group (p < 0.01). However, cf-PWV was not significantly different between the two CV risk groups (high versus very high) based on ESC criteria, and ESC criteria compared to STENO classified 10 patients more as having > 10% 10-year risk for CV events (n = 44/54; 81.5% versus n = 34/54; 63%). Conclusions This study demonstrated that a substantial proportion of long-standing T1D patients free from known CVD show premature arterial stiffening. Cf-PWV strongly associates with the STENO risk score for future CV events and with cardiovascular imaging and function outcomes, thereby illustrating the clinical importance of arterial stiffness. The data, however, also show considerable heterogeneity in CV risk and differences in risk categorisation between the STENO tool and ESC criteria.There is a need for refinement of CV risk classification in T1D, and future studies should investigate if evaluation of arterial stiffness should be implemented in T1D clinical practice and which patients benefit the most from its assessment.

Time-varying parameters of glycemic control and glycation in relation to arterial stiffness in patients with type 1 diabetes

“…Patients took part in this cross-sectional study [ 3 ] during 2019–2021 at our tertiary care centre if they met the following inclusion criteria: age > 18 years, T1D duration > 10 years and absence of known CVD ( i.e ., no history of angina pectoris, acute coronary syndrome, stroke, aortic disease, heart failure, symptomatic peripheral artery disease or any CV procedure or surgery) by consultation of patients’ electronic medical record as well as confirmed via patient reporting upon enrolment in the study. This study has been carried out in accordance with Ethical standards as mentioned in the Declaration of Helsinki for human experiments.…”

“…An a priori sample size calculation for F-test—Linear multiple regression fixed model was performed, using G*Power software version 3.1.9.4. The regression model needs to contain at least the factors proven to be associated with arterial stiffness, being age, BP and HbA1c level [ 3 , 5 , 29 ]. Additionally, we estimated that the model should be adjusted for two or three other covariates depending on the results of the univariate associations.…”

“…Arterial stiffness is a potential biomarker for complication risk in patients with type 1 diabetes (T1D), as its predictive role in the development of microvascular and cardiovascular disease (CVD) has been reported [ 1 , 2 ]. We have recently demonstrated that about one quarter of patients with T1D free from known CVD show premature arterial stiffening [ 3 ]. Moreover, arterial stiffness strongly associated with the STENO risk score for future cardiovascular (CV) events and with CV imaging and function outcomes, illustrating the clinical relevance of arterial stiffness [ 3 ].…”

“…We have recently demonstrated that about one quarter of patients with T1D free from known CVD show premature arterial stiffening [ 3 ]. Moreover, arterial stiffness strongly associated with the STENO risk score for future cardiovascular (CV) events and with CV imaging and function outcomes, illustrating the clinical relevance of arterial stiffness [ 3 ]. Considering its determinants, several patient- and disease-related factors have been investigated, with traditional risk factors age, blood pressure (BP) and glycated hemoglobin (HbA1c) being main predictors [ 3 – 6 ].…”

“…Moreover, arterial stiffness strongly associated with the STENO risk score for future cardiovascular (CV) events and with CV imaging and function outcomes, illustrating the clinical relevance of arterial stiffness [ 3 ]. Considering its determinants, several patient- and disease-related factors have been investigated, with traditional risk factors age, blood pressure (BP) and glycated hemoglobin (HbA1c) being main predictors [ 3 – 6 ]. However, the relationship of arterial stiffness with other time-varying parameters of glycemic control and glycation in T1D, such as advanced glycation end-products (AGEs; long-term) and continuous glucose monitoring (CGM)-derived parameters (short-term), has been far less explored.…”