Incident cardiovascular disease by clustering of favourable risk factors in type 1 diabetes: the EURODIAB Prospective Complications Study

Abstract

Aims The aim of this prospective study was to examine CVD risk reduction in type 1 diabetes (1) for people with favourable cardiovascular health metrics and (2) by clustering of these metrics. Methods Data from 2313 participants from the EURODIAB Prospective Complications Study were analysed. All had type 1 diabetes (51% men, mean ± SD age 32 ± 9 years). Seven cardiovascular health metrics were studied—smoking, BMI, physical activity, a diet score, total cholesterol/HDL-cholesterol ratio, combined systolic and diastolic BP and HbA1c—divided into favourable/less favourable categories. Cox proportional hazards models were used to calculate HRs (95% CIs) of incident CVD for each metric. Clusters were made by scoring each individual by the number of favourable metrics. Results A total of 163 people developed incident CVD during a mean ± SD follow-up of 7.2 ± 1.3 years. Participants with more favourable HbA1c levels of <57 mmol/mol (<7.4%) had a 37% significantly lower CVD risk than those with a less favourable HbA1c (HR [95% CI] 0.63 [0.44, 0.91]), and participants with a more favourable BP (systolic BP <112 mmHg and diastolic BP <70 mmHg) had a 44% significantly lower CVD risk than participants in the less favourable BP group (HR [95% CI] 0.56 [0.34, 0.92]). There was a dose–response relation with a lower HR observed with greater clustering of more favourable metrics: people with four or more favourable metrics had an HR of 0.37 (95% CI 0.18, 0.76), adjusted for sex and age at diabetes diagnosis, compared with those with no favourable metrics. Conclusions/interpretation Low HbA1c and low BP were protective cardiovascular health metrics in our study of people with type 1 diabetes. Targeting all cardiovascular health metrics could be more effective in preventing CVD than targeting single metrics. Graphical abstract

Differences in glycemic control in type 1 diabetes children and adolescents : in a national and international perspective and the effect on microvascular complications in young adults

“…T1D patients with low socioeconomic status have a higher risk for premature death and higher morbidity due to worse glycemic control (67). Other known factors for higher morbidity and mortality in T1D patients are smoking, high blood pressure, low physical activity, dysregulated cholesterol and overweight (68)(69)(70).…”

How dysregulation of the immune system promotes diabetes mellitus and cardiovascular risk complications

“…. T1D, the analysis of the EURODIAB prospective complications study revealed a reduced CV risk (0.37, 95% CI [0.18-0.76]) in patients presenting with at least 4 favorable health metrics, notably including the lower tertiles of systolic blood pressure and HbA1c levels (43). In addition, patients with DM suffer from painless myocardial infarction or silent diabetic ischemic cardiomyopathy, further increasing the difficulty of diagnosis (44).…”

“…As described above, patients with diabetes develop an accelerated and more severe form of atherosclerosis cardiovascular disease (ACVD), with a 3–4 times higher risk of suffering a CV event compared to the general population ( 5 , 42 , 43 ). However, there is an important heterogeneity of the CV risk among patients with DM.…”

“…For example in patients with T2D, the incidence of a major CV event is estimated at 10.5 times higher in individuals with a CAC score >400 compared to those with a zero CAC score ( 42 ). Likewise in patients with T1D, the analysis of the EURODIAB prospective complications study revealed a reduced CV risk (0.37, 95% CI [0.18–0.76]) in patients presenting with at least 4 favorable health metrics, notably including the lower tertiles of systolic blood pressure and HbA1c levels ( 43 ). In addition, patients with DM suffer from painless myocardial infarction or silent diabetic ischemic cardiomyopathy, further increasing the difficulty of diagnosis ( 44 ).…”

Lipid-lowering therapies and cardiovascular risk-stratification strategies in adults with type 1 diabetes

“…T1D may also be an ASCVD risk equivalent with respect to myocardial infarction [3 ▪ ]. Although intensive glycaemic control reduces ASCVD risk in T1D, significant residual risk remains, highlighting the importance of early ASCVD risk assessment and multifactorial risk factor control [3 ▪ ,4,5 ▪▪ ,6 ▪ ]. Dyslipidaemia is a modifiable risk factor that is prevalent and contributes to accelerated atherosclerosis in T1D.…”