Cardiovascular disease in type 1 diabetes

Abstract

Cardiovascular disease (CVD) is a well-recognized complication of diabetes. Although the association of type 2 diabetes with CVD has been well described, the mechanisms, risk stratification and screening strategies of CVD in type 1 diabetes (T1D) are less understood. This review aims to evaluate recent literature and guidelines regarding CVD in T1D. At the cellular level, the early stage of CVD is characterized by endothelial dysfunction. Recent studies have shown that endothelial function is unaffected in younger T1D patients but there is a significant degree of endothelial dysfunction in the older T1D population compared with healthy age-matched controls, highlighting the importance of the endothelial dysfunction in T1D as a major age-dependent cardiovascular risk factor. T1D risk assessment tools have been developed similar to those seen in type 2 diabetes. Foremost among these are the Danish Steno Type 1 risk engine, the Swedish T1D risk score, the Scottish T1D risk score and the QRISK risk calculator. The latter risk prediction tool is used for all patients but contains T1D as an independent risk variable and has the advantage of being derived from, and validated in, a large and diverse population. The latest version (QRISK3) is likely to be recommended for routine use in T1D patients in upcoming guidelines by the National Institute of Clinical Excellence. Mortality in adults with T1D is increasingly due to CVD. This is driven by hyperglycaemia-mediated oxidative stress and vascular inflammation, resulting in atherosclerosis and cardiac autonomic neuropathy. Coronary artery disease is the most significant contributor to CVD and in T1D, has a propensity towards a more silent and severe form. Routine screening of coronary artery disease does not alter outcomes and is therefore not recommended; however, risk prediction tools are being developed to aid identification of high-risk individuals for aggressive risk factor modification strategies.

Prediction for cardiovascular diseases based on laboratory data: An analysis of random forest model

“…14 There are also evidences suggesting that ORISK2 based on ORISK model is continuously undated to include additional risk factors like extension of age range, type 2 diabetes mellitus, and type 1 diabetes mellitus. 15,16 Therefore, it is necessary to investigate an approach that can integrate various risk factors better and confirm more accurate associations between outcomes and risk factors.…”

“…Additionally, multiple versions of Framingham models are reported to overpredict the incidence of CHD, 11‐13 and Framingham CVD model is poor in the calibration of the end point of major CVD 14 . There are also evidences suggesting that ORISK2 based on ORISK model is continuously undated to include additional risk factors like extension of age range, type 2 diabetes mellitus, and type 1 diabetes mellitus 15,16 . Therefore, it is necessary to investigate an approach that can integrate various risk factors better and confirm more accurate associations between outcomes and risk factors.…”

Role of peripheral 5-HT5A receptors in 5-HT-induced cardiac sympatho-inhibition in type 1 diabetic rats

“…The main causes of high morbidity and mortality in patients suffering from type 1 diabetes (T1D) continue to be cardiovascular complications, which are ten-fold increased in patients with T1D than in the general population 1 , 2 . Despite the notable improvement in life expectancy, patients with type 1 diabetes confront this increased cardiovascular risk, as it is silent in the at early stages of the disease (underestimated event), and due to the longer duration of the diabetic state compared to type 2 diabetes 3 – 5 . One of the triggers for cardiovascular disorders associated with diabetes is the sympathetic nervous system disorder at the cardiac level 6 , 7 .…”

Exclusive Peripheral Overexpression of 5-HT5A Receptors is Involved in 5‑HT‑Induced Cardiac Sympatho-Inhibition in Type 1 Diabetic Rats

“…The main causes of high morbidity and mortality in patients suffering from type 1 diabetes (T1D) continue to be cardiovascular complications, which are ten-fold increased in patients with T1D than in the general population [1,2]. Despite the notable improvement in life expectancy, patients with type 1 diabetes confront this increased cardiovascular risk, as it is silent in the at early stages of the disease (underestimated event), and due to the longer duration of the diabetic state compared to type 2 diabetes [3][4][5]. One of the triggers for cardiovascular disorders associated with diabetes is the sympathetic nervous system disorder at the cardiac level [6,7].…”