BACKGROUND

The extent of the performance and utility of scores for the risk of cardiovascular disease (CVD) in persons with type 1 diabetes (T1DM) largely remains unclear.

OBJECTIVE

The purpose of this study was to synthesize data on the performance of CVD risk scores in people living with T1DM.

METHODS

This study is a systematic review and meta-analysis. PubMed and EMBASE were searched through December 31, 2023. The included studies: 1) were retrospective, prospective, or cross-sectional in design; 2) included persons with T1DM; 3) assessed CVD outcomes; and 4) had data on at least on CVD risk score. Measures of calibration and discrimination qualitatively summarized. Measures of discrimination were combined using random-effects models stratified by type of risk model.

RESULTS

In a meta-analysis of observational studies of CVD risk scores in T1DM individuals, including 11 studies and 73,664 participants (mean age of 34 years, mainly White individuals and male [55%]), we evaluated 12 CVD risk prediction models (7 T1DM-specific, 1 type 2 diabetes-specific, and 4 general population models). Most risk scores had a moderate to excellent discrimination (C-statistic: 0.73-0.85) and predicted CVD risk well when compared to actual clinical events. CVD risk scores specifically developed in T1DM individuals exhibited a higher discriminative performance-pooled C-statistic of 0.81 vs 0.75 for risk scores developed in the general population or those with type 2 diabetes and also showed a better calibration.

CONCLUSIONS

Among individuals with T1DM, CVD risk models had a moderate to excellent discrimination, with a better discrimination and accuracy for T1DM-specific scores.