Department of Medicine, University of Padova, 35128 Padova, Italy.
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128, Padova, Italy.
Nutr Metab Cardiovasc Dis. 2020 Sep 24;30(10):1813-1819. doi: 10.1016/j.numecd.2020.07.006. Epub 2020 Jul 11.
Premature cardiovascular disease cause excess mortality in type 1 diabetes (T1D). The Steno T1D Risk Engine was developed and validated in northern European countries but its validity in other populations is unknown. We evaluated the performance of the Steno T1D Risk Engine in Italian patients with T1D.
We included patients with T1D with a baseline visit between July 2013 and April 2014, who were free of cardiovascular disease and had complete information to estimate risk. The estimated cardiovascular risk score was compared with the 5-year rate of cardiovascular events by means of logistic regression.
Among 223 patients (mean age 43 ± 13 years, 34.5% male, mean duration of diabetes 22 ± 12 years) the mean estimated cardiovascular risk at 5 years was 5.9% (95% C.I. 5.2-6.5%). At baseline, high estimated risk discriminated the presence of asymptomatic atherosclerosis better than microangiopathy, and was not associated with markers of inflammation or endothelial activation. After a mean follow-up of 4.7 ± 0.5 years, only 3 cardiovascular events were observed and nonetheless the risk score was significantly associated with their incidence (OR 1.22; 95% C.I. 1.08-1.39, p = 0.001). However, the observed event rate was significantly lower than the estimated one (3 vs 13; 95% C.I. 12-14; p < 0.001).
The Steno T1D Risk Score identified subjects with subclinical atherosclerosis and high cardiovascular risk in an Italian T1D population. However, the absolute risk was significantly overestimated. Further studies in larger population are needed to confirm these results.
1 型糖尿病（T1D）患者存在过早发生心血管疾病，导致死亡率增加。Steno T1D 风险引擎在北欧国家开发和验证，但在其他人群中的有效性尚不清楚。我们评估了 Steno T1D 风险引擎在意大利 T1D 患者中的表现。
我们纳入了 2013 年 7 月至 2014 年 4 月间基线访视的、无心血管疾病且具有完整风险估计信息的 T1D 患者。使用逻辑回归比较了估计的心血管风险评分与 5 年内心血管事件的发生率。
在 223 名患者（平均年龄 43 ± 13 岁，34.5%为男性，糖尿病病程平均为 22 ± 12 年）中，5 年的平均估计心血管风险为 5.9%（95%CI 5.2-6.5%）。在基线时，高估计风险比微血管病变更能预测无症状动脉粥样硬化的存在，并且与炎症或内皮激活标志物无关。平均随访 4.7 ± 0.5 年后，仅观察到 3 例心血管事件，但风险评分与事件发生率显著相关（OR 1.22；95%CI 1.08-1.39，p = 0.001）。然而，观察到的事件发生率明显低于估计的发生率（3 比 13；95%CI 12-14；p < 0.001）。
Steno T1D 风险评分在意大利 T1D 人群中识别出了亚临床动脉粥样硬化和高心血管风险的患者。然而，绝对风险被显著高估。需要在更大的人群中进行进一步的研究来证实这些结果。
