Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain.
Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain.
Diabetes Res Clin Pract. 2024 Aug;214:111771. doi: 10.1016/j.diabres.2024.111771. Epub 2024 Jul 4.
Evaluate the association between cumulative tobacco consumption (CTC; packs-year) and atherosclerosis in type 1 diabetes (T1D), and study whether the inclusion of CTC in the Steno T1 Risk Engine (ST1RE) equation improves the identification of plaques.
Cross-sectional study in T1D patients without cardiovascular disease (CVD), with ≥ 1 of the following: ≥40 years-old, diabetic kidney disease, and/or T1D duration ≥ 10 years + cardiovascular risk factors.Preclinical atherosclerosis was evaluated by carotid ultrasonography.
N = 584 patients were included (46.1 % women, age 48.7 ± 10.5 years, T1D duration 27.3 ± 10.8 years, 26.2 % active smokers). The overall plaque prevalence was 40.9 %. In models adjusted for age, sex, lipids, blood pressure, kidney function, statin use, microvascular complications and HbA, CTC was dose-dependently associated with the number of plaques (none, 1-2, ≥3) overall and in both active and former smokers (p < 0.001). This association remained after adjusting for ST1RE (OR 1.11 [1.02-1.19]). Although the inclusion of CTC in the ST1RE did not improve plaque identification overall (p = 0.180), it did so when analyzing active smokers separately (AUC 0.738 vs. 0.768; p < 0.01).
In T1D patients, CTC is dose-dependently associated with atherosclerosis. Further prospective studies are needed to determine if CTC could identify T1D individuals more prone to accelerated atherosclerosis.
评估 1 型糖尿病（T1D）患者中累积吸烟量（CTC；包年）与动脉粥样硬化之间的关系，并研究是否将 CTC 纳入 Steno T1 风险引擎（ST1RE）方程可以改善斑块的识别。
这是一项 T1D 患者的横断面研究，这些患者无心血管疾病（CVD），且至少有以下一项：年龄≥40 岁、糖尿病肾病和/或 T1D 病程≥10 年+心血管危险因素。通过颈动脉超声评估亚临床动脉粥样硬化。
共纳入 584 例患者（46.1%为女性，年龄 48.7±10.5 岁，T1D 病程 27.3±10.8 年，26.2%为现吸烟者）。总的斑块患病率为 40.9%。在调整年龄、性别、血脂、血压、肾功能、他汀类药物使用、微血管并发症和 HbA1c 后，CTC 与斑块数量（无、1-2 个、≥3 个）呈剂量依赖性相关，无论是在所有患者还是在现吸烟者和前吸烟者中（均 p<0.001）。这种相关性在调整 ST1RE 后仍然存在（OR 1.11[1.02-1.19]）。尽管 CTC 在 ST1RE 中的纳入并未整体改善斑块的识别（p=0.180），但在单独分析现吸烟者时则有所改善（AUC 为 0.738 比 0.768；p<0.01）。
在 T1D 患者中，CTC 与动脉粥样硬化呈剂量依赖性相关。需要进一步的前瞻性研究来确定 CTC 是否可以识别更容易发生加速动脉粥样硬化的 T1D 个体。
