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June 7, 2026Diabetes

ASCVD and PREVENT models underestimate 10-year CVD risk in type 1 diabetes by >2-fold.

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Why the study?

Cardiovascular disease limits quality of life and survival, and its accelerated course in type 1 diabetes may challenge standard risk prediction models.

Do traditional cardiovascular disease risk prediction models accurately predict 10-year CVD risk in patients with type 1 diabetes?

Population

1311 participants with type 1 diabetes in the EDIC study

Comparison

FRS vs ASCVD vs AHA PREVENT vs ST1RE risk prediction models, plus CAC and HbA1c

Design

Cohort study analysis

Follow-up

30 yrs

Key result

In type 1 diabetes, observed 10-year CVD risk was 1.43 times higher than predicted by FRS (95% CI 1.36-1.49) and >2-fold higher than ASCVD and PREVENT predictions.

Authors

VTVictoria R. TrapaniBBBARB BRAFFETTTCTINA COSTACOU

Discussion

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Member takes

Overview

Standard models may underestimate CVD risk in type 1 diabetes; leaves open whether CAC-enhanced scores improve outcomes.

Key Points

  • This research evaluates the effectiveness of cardiovascular disease risk prediction models in individuals with type 1 diabetes over a 30-year period.
  • Included 1311 participants from the Epidemiology of Diabetes Interventions and Complications study, followed for 30 years.
  • Assessed the performance of multiple risk prediction models using observed cardiovascular disease incidence.
  • Evaluated the impact of coronary artery calcification and HbA1c on risk classification.
  • At Year 20, the observed CVD risk was 1.43 times higher than predicted by FRS and more than two-fold higher than ASCVD and PREVENT (RR 2.69, 95% CI 2.55-2.86).
  • Models underpredicted CVD risk in females, while ST1RE showed better predictions.
  • Increased discrimination (c-statistic to 0.68) was achieved by incorporating CAC scores into the risk assessments.

Study Design

Type

Cohort (n=1,311)

Structured PICO

Do traditional cardiovascular disease risk prediction models accurately predict 10-year CVD risk in patients with type 1 diabetes?

P
Population
1,311 participants with type 1 diabetes from the EDIC study, followed for 30 years to assess the performance of cardiovascular risk prediction models.
E
Exposure
Cardiovascular disease risk prediction models (Framingham Risk Score [FRS], ASCVD Risk Estimator Plus, AHA PREVENT, and Steno Type 1 Risk Engine [ST1RE]) and risk enhancers (coronary artery calcification [CAC] and HbA1c)
C
Comparator
Observed cardiovascular disease incidence
O
Outcome
10-year cardiovascular disease risk performance (calibration and c-statistics) at Years 1, 10, and 20 compared to observed CVD incidence during subsequent intervalshard clinical

Main Result

Relative Risk: 1.43 (95% CI 1.36–1.49)

Traditional cardiovascular risk prediction models significantly underestimate risk in patients with type 1 diabetes, highlighting the need for tailored risk estimation incorporating enhancers like CAC and HbA1c.

Cite This Study

Trapani et al. (2026) conducted a cohort in Type 1 Diabetes (n=1,311). Traditional CVD risk prediction models (FRS, ASCVD, PREVENT, ST1RE) vs. Observed CVD incidence was evaluated on 10-year cardiovascular disease incidence compared to model-predicted risk (RR 1.43, 95% CI 1.36-1.49). In type 1 diabetes, observed 10-year CVD risk was 1.43 times higher than predicted by FRS (95% CI 1.36-1.49) and >2-fold higher than ASCVD and PREVENT predictions.

synapsesocial.com/papers/6a250cbc7def13d035e1cee1https://doi.org/10.2337/db26-2965-lb
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cardiovascular risk assessment in adults with type 1 diabetes: A cross-sectional comparison of two prediction models2026
  2. 2Predicting subclinical atherosclerosis in adults with type 1 diabetes using cardiovascular risk models: a cross‑sectional study from Italy2026
  3. 32983-LB: Trajectories of Risk Factors among Participants with Long-Duration Type 1 Diabetes2026
  4. 4185-OR: The Role of Optical Coherent Tomography in the Estimation of Cardiovascular Risk in Asymptomatic Patients with Type 1 Diabetes2024
  5. 51458-P: Cardiovascular Risk Is Higher in People with Type 1 Diabetes Living with Overweight or Obesity—Insights from the SFDT1 Cohort2024 · 1 citations