Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
IISPV Pere Virgili Health Research Institute, Tarragona, Spain.
PLoS One. 2019 Sep 4;14(9):e0220206. doi: 10.1371/journal.pone.0220206. eCollection 2019.
Currently used risk scores for type 2 diabetes mellitus (T2DM) clearly underestimate cardiovascular risk in type 1 diabetes (T1DM). Hence, there is a need to develop novel and specific risk-estimation tools for this population. We aimed to assess the relationship between the Steno Type 1 Risk Engine (ST1RE) and arterial stiffness (AS), and to identify potential cut-off points of interest in clinical practice.
A total of 179 patients with T1DM (50.8% men, mean age 41.2±13.1 years), without established cardiovascular disease, were evaluated for clinical and anthropometric data (including classical cardiovascular risk factors), and AS measured by aortic pulse-wave velocity (aPWV). The ST1RE was used to estimate 10-year cardiovascular risk and patients were classified into 3 groups: low- (<10%; n = 105), moderate- (10-20%; n = 53) and high-risk (≥20%; n = 21).
When compared with the low- and moderate-risk groups, patients in the high-risk group were older, had higher prevalence of hypertension, dyslipidemia and insulin-resistance, and had higher body-mass index and HbA1c. aPWV increased in parallel with estimated cardiovascular risk (6.4±1.0, 8.4±1.3 and 10.3±2.6m/s; p<0.001). As an evaluation of model performance, the C-statistic of aPWV was 0.914 (95% confidence interval [CI]:0.873-0.950) for predicting moderate/high-risk and 0.879 (95%CI:0.809-0.948) for high-risk, according to the ST1RE. The best cut-off points of aPWV were 7.3m/s (sensitivity:86%, specificity:83%) and 8.7m/s (sensitivity:76%, specificity:86%) for moderate/high- and high-risk, respectively.
AS is highly correlated with the scores obtained from the ST1RE. We have identified two cut-off points of AS that can clearly discriminate moderate/high- and high-risk T1DM patients, which could be of great value in clinical practice.
目前用于 2 型糖尿病（T2DM）的风险评分明显低估了 1 型糖尿病（T1DM）的心血管风险。因此，需要为该人群开发新的、特异性的风险评估工具。我们旨在评估 Steno 1 型风险引擎（ST1RE）与动脉僵硬度（AS）之间的关系，并确定在临床实践中有意义的潜在切点。
共评估了 179 例 T1DM 患者（50.8%为男性，平均年龄 41.2±13.1 岁）的临床和人体测量数据（包括经典心血管危险因素）以及主动脉脉搏波速度（aPWV）。使用 ST1RE 估计 10 年心血管风险，患者被分为 3 组：低危（<10%；n=105）、中危（10-20%；n=53）和高危（≥20%；n=21）。
与低危和中危组相比，高危组患者年龄较大，高血压、血脂异常和胰岛素抵抗的患病率较高，体重指数和糖化血红蛋白（HbA1c）也较高。aPWV 随估计的心血管风险增加而平行增加（6.4±1.0、8.4±1.3 和 10.3±2.6m/s；p<0.001）。作为模型性能的评估，根据 ST1RE，aPWV 预测中危/高危的 C 统计量为 0.914（95%置信区间[CI]：0.873-0.950），预测高危的 C 统计量为 0.879（95%CI：0.809-0.948）。aPWV 的最佳切点为 7.3m/s（敏感性：86%，特异性：83%）和 8.7m/s（敏感性：76%，特异性：86%），分别用于中危/高危和高危。
AS 与 ST1RE 评分高度相关。我们已经确定了两个 AS 的切点，可以清楚地区分中危/高危 T1DM 患者，这在临床实践中可能具有重要价值。
