Division of Endocrinology and Diabetes, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.
Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.
Front Endocrinol (Lausanne). 2024 Nov 13;15:1505430. doi: 10.3389/fendo.2024.1505430. eCollection 2024.
Type 1 diabetes (T1D) is a chronic condition marked by insulin deficiency and hyperglycemia, with an increasing global incidence, particularly among children. Despite improvements in diabetes management, individuals with T1D continue to experience higher rates of cardiovascular disease (CVD), the leading cause of mortality in this population. Traditional CVD risk factors such as dyslipidemia and poor glycemic control are insufficient to fully explain the elevated risk in T1D, prompting further investigation into additional factors. Emerging evidence suggests that metabolic dysfunction-associated steatotic liver disease (MASLD) plays a critical role in this heightened CVD risk.
This narrative review aims to explore the relationship between MASLD and CVD in individuals with T1D. The review focuses on the prevalence of MASLD, its contributing risk factors, and the potential impact of liver dysfunction on cardiovascular outcomes in this population.
A review of existing literature was conducted, focusing on observational studies, cohort studies, and meta-analyses that investigate the prevalence of MASLD in T1D populations and its association with CVD. The review also examines the physiological mechanisms linking MASLD and CVD, including insulin resistance, systemic inflammation, and hepatic dyslipidemia. Key studies were evaluated to identify patterns in MASLD prevalence based on diagnostic modalities and to assess the independent contribution of MASLD to cardiovascular risk in T1D patients.
MASLD is increasingly recognized as a significant contributor to CVD in individuals with T1D, particularly in those with shared risk factors like obesity and insulin resistance. Evidence suggests that MASLD exacerbates hepatic and systemic metabolic dysfunction, increasing CVD risk through mechanisms such as chronic inflammation and atherogenic lipid profiles. Routine liver health assessments and tailored management strategies targeting MASLD should be incorporated into clinical care for individuals with T1D to mitigate long-term cardiovascular complications.
1 型糖尿病（T1D）是一种以胰岛素缺乏和高血糖为特征的慢性疾病，其全球发病率不断上升，尤其是在儿童中。尽管糖尿病管理有所改善，但 T1D 患者仍面临更高的心血管疾病（CVD）发病率，这是该人群的主要死亡原因。传统的 CVD 风险因素，如血脂异常和血糖控制不佳，不足以完全解释 T1D 中的高风险，这促使人们进一步研究其他因素。新出现的证据表明，代谢功能障碍相关脂肪性肝病（MASLD）在这种 CVD 风险增加中起着关键作用。
本叙述性综述旨在探讨 MASLD 与 T1D 个体 CVD 之间的关系。本综述重点关注 MASLD 的患病率、其促成风险因素，以及肝功能障碍对该人群心血管结局的潜在影响。
对现有文献进行了综述，重点关注研究 T1D 人群中 MASLD 患病率及其与 CVD 相关性的观察性研究、队列研究和荟萃分析。本综述还研究了将 MASLD 与 CVD 联系起来的生理机制，包括胰岛素抵抗、全身炎症和肝脂代谢异常。评估了关键研究，以确定基于诊断方式的 MASLD 患病率模式，并评估 MASLD 对 T1D 患者心血管风险的独立贡献。
MASLD 越来越被认为是 T1D 个体 CVD 的一个重要促成因素，尤其是在肥胖和胰岛素抵抗等共同风险因素存在的情况下。有证据表明，MASLD 加剧了肝和全身代谢功能障碍，通过慢性炎症和动脉粥样硬化脂质谱等机制增加 CVD 风险。应将 MASLD 的常规肝脏健康评估和针对 MASLD 的个体化管理策略纳入 T1D 患者的临床护理中，以减轻长期心血管并发症。
