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Use of the Steno T1 Risk Engine Identifies Preclinical Atherosclerosis Better Than Use of ESC/EASD-2019 in Adult Subjects With Type 1 Diabetes at High Risk
Diabetes Care ( IF 14.8 ) Pub Date : 2022-08-09 , DOI: 10.2337/dc22-0118
Tonet Serés-Noriega 1 , Marga Giménez 2, 3 , Verónica Perea 4 , Laura Boswell 1, 5 , Clara Viñals 1 , Jesús Blanco 2, 3 , Irene Vinagre 2 , Adriana Pané 1 , Enric Esmatjes 2, 3 , Ignacio Conget 2, 3 , Antonio J Amor 1
Affiliation  

OBJECTIVE To evaluate the concordance between the 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD (ESC/EASD-2019) and the Steno T1 Risk Engine (Steno-Risk) cardiovascular risk scales for individuals with type 1 diabetes (T1D) without cardiovascular disease (CVD) and to analyze the relationships of their use with identification of preclinical atherosclerosis. RESEARCH DESIGN AND METHODS We consecutively selected patients with T1D, without CVD, age ≥40 years, with nephropathy, and/or with ≥10 years of T1D evolution with another risk factor. The presence of plaque at different carotid segments was determined by ultrasonography. Cardiovascular risk was estimated in accord with ESC/EASD-2019 risk groups (moderate/high/very high) and the Steno-Risk (<10%, low; 10–20%, moderate; ≥20%, high), as T1D-specific scores. In an exploratory analysis, we also evaluated the non-T1D-specific 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk (ACC/AHA-2013) pooled cohort equation for individuals between 40 and 79 years of age. RESULTS We included 501 patients (53% men, mean age 48.8 years, median T1D duration 26.5 years, 41.3% harboring plaques). Concordance between T1D-specific scales was poor (κ = 0.19). A stepped increase in the presence of plaques according to Steno-Risk category was seen (18.4%, 38.2%, and 64.1%, for low, moderate, and high risk, respectively; P for trend <0.001), with no differences according to ESC/EASD-2019 (P = 0.130). Steno-Risk identified individuals with plaques, unlike ESC/EASD-2019 (area under the curve [AUC] 0.691, P < 0.001, vs. AUC 0.538, P = 0.149). Finally, in polynomial regression models (with adjustment for lipid parameters and cardioprotective treatment), irrespective of the ESC/EASD-2019 category, high risk by Steno-Risk was directly associated with atherosclerosis (in moderate/high-risk by ESC/EASD-2019 odds ratio 2.91 [95% CI 1.27–6.72] and 4.94 [2.35–10.40] for the presence of plaque and two or more plaques). Similar results were obtained with discordant higher Steno-Risk versus ACC/AHA-2013 (P < 0.001). CONCLUSIONS Among T1D patients undergoing primary prevention, use of Steno-Risk seems to result in better recognition of individuals with atherosclerosis in comparison with ESC/EASD-2019. Notwithstanding, carotid ultrasound could improve the categorization of cardiovascular risk.

中文翻译:

使用 Steno T1 风险引擎比使用 ESC/EASD-2019 在高风险 1 型糖尿病成年受试者中更好地识别临床前动脉粥样硬化

目的 评估与 EASD (ESC/EASD-2019) 合作制定的 2019 年 ESC 糖尿病、糖尿病前期和心血管疾病指南与 Steno T1 风险引擎 (Steno-Risk) 心血管风险量表之间的一致性没有心血管疾病 (CVD) 的 1 型糖尿病 (T1D),并分析它们的使用与临床前动脉粥样硬化的鉴定之间的关系。研究设计和方法 我们连续选择患有 T1D、无 CVD、年龄≥40 岁、患有肾病和/或 T1D 演变≥10 年并伴有其他危险因素的患者。通过超声检查确定不同颈动脉节段是否存在斑块。根据 ESC/EASD-2019 风险组(中/高/极高)和 Steno-Risk(<10%,低;10-20%,中等;≥20%,高),作为 T1D 特异性分数。在一项探索性分析中,我们还评估了 2013 年 ACC/AHA 心血管风险评估指南 (ACC/AHA-2013) 中针对 40 至 79 岁个体的汇总队列方程。结果 我们纳入了 501 名患者(53% 为男性,平均年龄 48.8 岁,中位 T1D 持续时间 26.5 年,41.3% 患有斑块)。T1D 特定量表之间的一致性很差 (κ = 0.19)。根据 Steno-Risk 类别,可以看到斑块的存在逐步增加(低、中、高风险分别为 18.4%、38.2% 和 64.1%;趋势 P <0.001),根据根据 ESC/EASD-2019 (P = 0.130)。与 ESC/EASD-2019 不同(曲线下面积 [AUC] 0.691,P < 0.001,对比 AUC 0.538,P = 0.149),Steno-Risk 识别出有斑块的个体。最后,在多项式回归模型(调整脂质参数和心脏保护治疗)中,无论 ESC/EASD-2019 类别如何,Steno-Risk 的高风险与动脉粥样硬化直接相关(ESC/EASD-2019 赔率的中/高风险存在斑块和两个或更多斑块的比率 2.91 [95% CI 1.27–6.72] 和 4.94 [2.35–10.40])。与 ACC/AHA-2013 相比,Steno-Risk 不一致的情况下获得了类似的结果(P < 0.001)。结论 在接受一级预防的 T1D 患者中,与 ESC/EASD-2019 相比,使用 Steno-Risk 似乎可以更好地识别动脉粥样硬化患者。尽管如此,颈动脉超声可以改善心血管风险的分类。无论 ESC/EASD-2019 类别如何,Steno-Risk 的高风险与动脉粥样硬化直接相关(ESC/EASD-2019 的中度/高风险比值比 2.91 [95% CI 1.27–6.72] 和 4.94 [2.35– 10.40] 存在斑块和两个或更多斑块)。与 ACC/AHA-2013 相比,Steno-Risk 不一致的情况下获得了类似的结果(P < 0.001)。结论 在接受一级预防的 T1D 患者中,与 ESC/EASD-2019 相比,使用 Steno-Risk 似乎可以更好地识别动脉粥样硬化患者。尽管如此,颈动脉超声可以改善心血管风险的分类。无论 ESC/EASD-2019 类别如何,Steno-Risk 的高风险与动脉粥样硬化直接相关(ESC/EASD-2019 的中度/高风险比值比 2.91 [95% CI 1.27–6.72] 和 4.94 [2.35– 10.40] 存在斑块和两个或更多斑块)。与 ACC/AHA-2013 相比,Steno-Risk 不一致的情况下获得了类似的结果(P < 0.001)。结论 在接受一级预防的 T1D 患者中,与 ESC/EASD-2019 相比,使用 Steno-Risk 似乎可以更好地识别动脉粥样硬化患者。尽管如此,颈动脉超声可以改善心血管风险的分类。40] 存在斑块和两个或更多斑块)。与 ACC/AHA-2013 相比,Steno-Risk 不一致的情况下获得了类似的结果(P < 0.001)。结论 在接受一级预防的 T1D 患者中,与 ESC/EASD-2019 相比,使用 Steno-Risk 似乎可以更好地识别动脉粥样硬化患者。尽管如此,颈动脉超声可以改善心血管风险的分类。40] 存在斑块和两个或更多斑块)。与 ACC/AHA-2013 相比,Steno-Risk 不一致的情况下获得了类似的结果(P < 0.001)。结论 在接受一级预防的 T1D 患者中,与 ESC/EASD-2019 相比,使用 Steno-Risk 似乎可以更好地识别动脉粥样硬化患者。尽管如此,颈动脉超声可以改善心血管风险的分类。
更新日期:2022-08-09
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