1型糖尿病地中海人群中的斯滕诺1型风险引擎与临床前期动脉粥样硬化

Steno type 1 risk engine and preclinical atherosclerosis in Mediterranean individuals with type 1 diabetes.

作者信息

Viñals C, Conget I, Pané A, Boswell L, Perea V, Blanco A J, Ruiz S, Giménez M, Vinagre I, Esmatjes E, Ortega E, Amor A J

机构信息

Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain.

Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain.

出版信息

Diabetes Metab Res Rev. 2020 Oct;36(7):e3320. doi: 10.1002/dmrr.3320. Epub 2020 Apr 13.

DOI:10.1002/dmrr.3320

PMID:32239693

Abstract

BACKGROUND AND AIMS

Tools to detect type 1 diabetes (T1D) individuals at overt cardiovascular disease (CVD) risk are scarce. We aimed to assess the usefulness of the score 'Steno Type 1 Risk Engine' (Steno-Risk) to identify T1D patients with advanced carotid atherosclerosis.

MATERIAL AND METHODS

T1D patients without CVD with at least one of the following were included: ≥40 years, diabetic nephropathy, or diabetes duration ≥10 years with ≥1 CVD risk factor. Intima-media thickness (IMT) and plaque presence (IMT ≥1.5 mm) were assessed by standardized B-mode ultrasonography. Steno-Risk was used to estimate 10-year risk (<10% low; 10%-20% moderate; ≥20% high risk). Associations between Steno-Risk and preclinical atherosclerosis were assessed after adjusting for other CVD risk factors.

RESULTS

We evaluated 302 patients (55% men, age 47.8 ± 9.8 years, T1D duration 26.3 ± 9.3 years). The prevalence of carotid plaque and ≥2 plaques were 36.4% and 19.2%, respectively; without sex differences. Age (57.4 ± 7.4 vs 37.1 ± 6.2 years), T1D duration (31.3 ± 10.4 vs 21.5 ± 7.1 years), hypertension (52.3% vs 6.3%), nephropathy (25.6% vs 5.1%) and retinopathy (53.5% vs 32.9%) were higher in high-risk (n = 86) vs low-risk participants (n = 79; P < .001 for all). Preclinical atherosclerosis (IMT and plaque) increased in parallel with Steno-Risk (P < .001). In logistic regression analysis, both age ≥40 years and Steno-Risk ≥20% were associated with the presence of plaque (OR 4.22 [1.57-11.36] and 3.79 [1.61-6.80]; respectively), but only high Steno-Risk remained independently associated with ≥2 plaques (OR 3.31 [1.61-6.80]).

CONCLUSION

Steno-Risk is independently associated with preclinical atherosclerosis. Further studies are needed to ascertain its usefulness in this high-risk population.

摘要

背景与目的

用于检测处于明显心血管疾病（CVD）风险的1型糖尿病（T1D）患者的工具稀缺。我们旨在评估“斯滕诺1型风险评估工具”（Steno-Risk）对识别患有晚期颈动脉粥样硬化的T1D患者的有效性。

材料与方法

纳入无CVD且具有以下至少一项特征的T1D患者：年龄≥40岁、糖尿病肾病、糖尿病病程≥10年且伴有≥1个CVD风险因素。通过标准化B型超声评估内膜中层厚度（IMT）和斑块存在情况（IMT≥1.5mm）。使用Steno-Risk评估10年风险（<10%为低风险；10%-20%为中度风险；≥20%为高风险）。在对其他CVD风险因素进行校正后，评估Steno-Risk与临床前期动脉粥样硬化之间的关联。

结果

我们评估了302例患者（55%为男性，年龄47.8±9.8岁，T1D病程26.3±9.3年）。颈动脉斑块和≥2个斑块的患病率分别为36.4%和19.2%；无性别差异。高风险组（n = 86）与低风险组（n = 79）相比，年龄（57.4±7.4岁对37.1±6.2岁）、T1D病程（31.3±10.4年对21.5±7.1年）、高血压（52.3%对6.3%）、肾病（25.6%对5.1%）和视网膜病变（53.5%对32.9%）更高（所有P<0.001）。临床前期动脉粥样硬化（IMT和斑块）与Steno-Risk呈平行增加（P<0.001）。在逻辑回归分析中，年龄≥40岁和Steno-Risk≥20%均与斑块存在相关（OR分别为4.22[1.57 - 11.36]和3.79[1.61 - 6.80]），但只有高Steno-Risk与≥2个斑块独立相关（OR为3.31[1.61 - 6.80]）。