Serés-Noriega Tonet, Perea Verónica, Amor Antonio J
Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, 08036 Barcelona, Spain.
Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain.
J Clin Med. 2024 Feb 15;13(4):1097. doi: 10.3390/jcm13041097.
People with type 1 diabetes (T1D) have a high cardiovascular disease (CVD) risk, which remains the leading cause of death in this population. Despite the improved control of several classic risk factors, particularly better glycaemic control, cardiovascular morbidity and mortality continue to be significantly higher than in the general population. In routine clinical practice, estimating cardiovascular risk (CVR) in people with T1D using scales or equations is often imprecise because much of the evidence comes from pooled samples of people with type 2 diabetes (T2D) and T1D or from extrapolations of studies performed on people with T2D. Given that T1D onsets at a young age, prolonged exposure to the disease and its consequences (e.g., hyperglycaemia, changes in lipid metabolism or inflammation) have a detrimental impact on cardiovascular health. Therefore, it is critical to have tools that allow for the early identification of those individuals with a higher CVR and thus be able to make the most appropriate management decisions in each case. In this sense, atherosclerosis is the prelude to most cardiovascular events. People with diabetes present pathophysiological alterations that facilitate atherosclerosis development and that may imply a greater vulnerability of atheromatous plaques. Screening for subclinical atherosclerosis using various techniques, mainly imaging, has proven valuable in predicting cardiovascular events. Its use enables the reclassification of CVR and, therefore, an individualised adjustment of therapeutic management. However, the available evidence in people with T1D is scarce. This narrative review provides and updated overview of the main non-invasive tests for detecting atherosclerosis plaques and their association with CVD in people with T1D.
1型糖尿病（T1D）患者心血管疾病（CVD）风险较高，这仍是该人群的主要死因。尽管一些经典危险因素的控制有所改善，尤其是血糖控制更佳，但心血管疾病的发病率和死亡率仍显著高于普通人群。在常规临床实践中，使用量表或公式评估T1D患者的心血管风险（CVR）往往不够精确，因为许多证据来自2型糖尿病（T2D）和T1D患者的汇总样本，或来自对T2D患者进行的研究推断。鉴于T1D发病于年轻时，长期患病及其后果（如高血糖、脂质代谢变化或炎症）会对心血管健康产生不利影响。因此，拥有能够早期识别CVR较高个体的工具至关重要，这样才能在每种情况下做出最合适的管理决策。从这个意义上说，动脉粥样硬化是大多数心血管事件的前奏。糖尿病患者存在促进动脉粥样硬化发展的病理生理改变，这可能意味着动脉粥样硬化斑块更易破裂。使用各种技术（主要是影像学）筛查亚临床动脉粥样硬化已被证明在预测心血管事件方面具有重要价值。其应用能够对CVR进行重新分类，从而实现治疗管理的个体化调整。然而，T1D患者的现有证据很少。本叙述性综述提供并更新了检测T1D患者动脉粥样硬化斑块的主要非侵入性检查及其与CVD关联的概述。
