Viñals Clara, Conget Ignacio, Granados Montse, Solà Clara, Ayala Denisse, Mesa Alex, Serés-Noriega Tonet, Domenech Mònica, Perea Verónica, Blanco Jesús, Vinagre Irene, Giménez Marga, Amor Antonio J
Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain.
The Clinic Foundation for Biomedical Research, August Pi Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain.
J Clin Med. 2025 Aug 25;14(17):6004. doi: 10.3390/jcm14176004.
Individuals with type 1 diabetes (T1DM) face an elevated risk of cardiovascular disease (CVD), yet the factors driving atherosclerosis remain unclear. This study aimed to assess factors associated with preclinical atherosclerosis development or progression in T1DM. We conducted a prospective study in T1DM individuals without established CVD, aged ≥40 years, with diabetic kidney disease and/or ≥10 years of T1DM plus another cardiovascular risk factor (CVRF). Baseline evaluation followed a standardized CV risk assessment protocol, including carotid ultrasound and cardiovascular risk estimation using the Steno Type 1 Risk Engine (ST1RE). Ultrasound was repeated after 3-5 years; progression was defined as an increase in plaque number. CVRF control was considered optimal when LDL-cholesterol was within target based on atherosclerotic burden, blood pressure <130/80 mmHg, HbA1c <7%, and non-smoking status. Logistic regression models identified predictors of progression. We included 151 participants (55.6% women; mean age 49.8 ± 8.9 years; T1DM duration 27.3 ± 9.1 years); 42.4% had plaques at baseline. Over a follow-up of 5.22 ± 1.29 years, despite improved CVRF control ( < 0.05), 40.4% experienced progression. Older age (OR 1.38 [1.1-1.8]) and active smoking (OR 3.29 [1.4-7.5]) were significant predictors of progression. Baseline cardiovascular risk measured by the ST1RE independently predicted progression (OR 1.09 [1.03-1.15]) after adjusting for other CVRFs. Persistent smoking (OR 2.52 [1.06-5.99]) and baseline ST1RE (OR 1.06 [1.02-1.11]) remained significant after accounting for baseline and follow-up CVRFs. Despite improved CVRF control, atherosclerosis progression is common in T1D. ST1RE may help identify individuals at highest risk for targeted preventive strategies.
1型糖尿病（T1DM）患者面临着更高的心血管疾病（CVD）风险，然而驱动动脉粥样硬化的因素仍不明确。本研究旨在评估与T1DM患者临床前期动脉粥样硬化发展或进展相关的因素。我们对年龄≥40岁、患有糖尿病肾病和/或患T1DM达10年以上且伴有另一种心血管危险因素（CVRF）、无已确诊CVD的T1DM患者进行了一项前瞻性研究。基线评估遵循标准化的心血管风险评估方案，包括颈动脉超声检查以及使用斯滕诺1型风险引擎（ST1RE）进行心血管风险评估。3至5年后重复进行超声检查；进展定义为斑块数量增加。当低密度脂蛋白胆固醇根据动脉粥样硬化负担处于目标范围内、血压<130/80 mmHg、糖化血红蛋白<7%且为非吸烟状态时，CVRF控制被视为最佳。逻辑回归模型确定了进展的预测因素。我们纳入了151名参与者（55.6%为女性；平均年龄49.8±8.9岁；T1DM病程27.3±9.1年）；42.4%的参与者在基线时有斑块。在5.22±1.29年的随访期间，尽管CVRF控制有所改善（<0.05），但仍有40.4%的患者出现进展。年龄较大（比值比[OR]1.38[1.1 - 1.8]）和当前吸烟（OR 3.29[1.4 - 7.5]）是进展的显著预测因素。在调整其他CVRF后，由ST1RE测量的基线心血管风险独立预测进展（OR 1.09[1.03 - 1.15]）。在考虑基线和随访CVRF后，持续吸烟（OR 2.52[1.06 - 5.99]）和基线ST1RE（OR 1.06[1.02 - 1.11]）仍然显著。尽管CVRF控制有所改善，但动脉粥样硬化进展在T1D中很常见。ST1RE可能有助于识别最有风险的个体，以便采取针对性的预防策略。
