Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, UK.
Diabetes Obes Metab. 2013 Mar;15(3):198-203. doi: 10.1111/dom.12013. Epub 2012 Oct 24.
Diabetes mellitus is associated with excess cardiovascular mortality that is evident in all age groups, but is most pronounced in young people with type 1 diabetes. Cardiovascular risk estimation models generally estimate the probability of future events over a 10-year time horizon. Due to the dependency on age, children and adolescents with type 1 diabetes would be considered at low short-term risk but high life-time risk of developing a cardiovascular event. Guidelines recommend screening particularly for microvascular complications including nephropathy and retinopathy beginning around puberty. Identification of early microvascular abnormalities in children and adolescents not only predict later development of long-term microvascular complications and further end-organ damage but are associated with an increased risk for future macrovascular events. This may be because of the fact that the same glycaemic mechanisms responsible for the occurrence of microvascular disease may also apply to the development of atherosclerosis. Alternatively, interventions that reduce the development of microvascular end-organ damage may also delay the development of associated macrovascular disease. Screening for subclinical atherosclerosis, especially in the coronary and carotid vessels, has been advocated as a means of detecting early atherosclerotic disease in asymptomatic individuals with the aim of potentially reclassifying cardiovascular risk and guiding therapeutic interventions. Currently there is no randomized clinical trial evidence that additional screening using non-invasive imaging techniques alters cardiovascular disease outcomes. We do not know the best approach or combination of approaches to assess risk and reduce cardiovascular disease burden in type 1 diabetes mellitus. All screening interventions carry harms as well as benefits and until further evidence becomes available additional screening using non-invasive imaging tests for the detection of subclinical atherosclerosis cannot be currently recommended for patients with type 1 diabetes.
糖尿病与心血管死亡率增加有关，这种死亡率在所有年龄段都很明显，但在 1 型糖尿病的年轻人中最为明显。心血管风险评估模型通常估计未来 10 年内发生事件的概率。由于依赖于年龄，1 型糖尿病的儿童和青少年在短期内被认为风险较低，但终生患心血管事件的风险较高。指南建议对包括肾病和视网膜病变在内的微血管并发症进行筛查，特别是在青春期左右开始。在儿童和青少年中识别早期微血管异常不仅可以预测长期微血管并发症和进一步的终末器官损害的发生，还与未来大血管事件的风险增加有关。这可能是因为导致微血管疾病发生的相同血糖机制也可能适用于动脉粥样硬化的发展。或者，减少微血管终末器官损伤发展的干预措施也可能延迟相关大血管疾病的发展。筛查亚临床动脉粥样硬化，特别是在冠状动脉和颈动脉中，一直被提倡作为一种检测无症状个体早期动脉粥样硬化疾病的方法，目的是潜在地重新分类心血管风险，并指导治疗干预。目前，没有随机临床试验证据表明使用非侵入性成像技术进行额外的筛查可以改变心血管疾病的结局。我们不知道评估风险和减少 1 型糖尿病心血管疾病负担的最佳方法或方法组合。所有筛查干预都有危害和益处，在进一步的证据出现之前，不能推荐对 1 型糖尿病患者使用非侵入性成像测试进行亚临床动脉粥样硬化的额外筛查。
