The ST1RE and Scottish-Swedish risk scores strongly discriminated imaging-defined subclinical atherosclerosis in asymptomatic adults with type 1 diabetes, with AUCs of 0.899 and 0.907, respectively.
Cross-Sectional (n=101)
No
Do T1D-specific cardiovascular risk models (ST1RE and Scottish-Swedish) better predict subclinical atherosclerosis compared to 2019 ESC guidelines in asymptomatic adults with type 1 diabetes?
Type 1 diabetes-specific cardiovascular risk scores (ST1RE and Scottish-Swedish) accurately identify subclinical atherosclerosis in asymptomatic adults with T1D, significantly outperforming standard 2019 ESC guidelines.
Effect estimate: AUC 0.899 (ST1RE) and 0.907 (Scottish-Swedish)
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among individuals with type 1 diabetes (T1D); nevertheless, cardiovascular risk stratification remains an unmet need in T1D. Cardiovascular risk tools were developed to predict 10‑year clinical events. Whether they identify subclinical atherosclerosis - a potential gatekeeper for intensified prevention - remains uncertain. We conducted a cross-sectional analysis of consecutive T1D adults without a history of CVD enrolled at a secondary centre in Italy. All participants underwent coronary computed tomography angiography (CCTA) and carotid ultrasound. The primary outcome was a composite imaging endpoint, defined as any coronary plaque on CCTA and/or maximum carotid intima-media thickness (cIMT max ) ≥ 1.5 mm. We compared the performance of T1D-specific CV risk models (2019 European Society of Cardiology ESC Guidelines, Steno Type 1 Risk Engine ST1RE, and Scottish-Swedish CVD risk prediction tool) in predicting the presence of subclinical atherosclerosis. Discrimination was assessed using the Area Under the receiver operating characteristic Curve (AUC), and differences between AUCs were evaluated using the DeLong test; calibration was visualised with calibration plots and summarised by Brier score. Sensitivity analyses evaluated CCTA‑only and carotid‑only endpoints. One hundred and one patients (52.5% males) were included in the study, with a mean age of 45 ± 13 years and a median diabetes duration of 21 years (Q1–Q3 13; 32). The composite imaging endpoint occurred in 66/101 (65.4%); 55 patients (54.5%) had coronary plaques, and 41 patients (40.6%) presented cIMT max above threshold. Both ST1RE and the Scottish-Swedish risk scores showed strong discrimination for the combined imaging endpoint (AUC 0.899 and 0.907, respectively). Apparent calibration to the imaging endpoint was acceptable, with Brier scores of 0.126 for ST1RE and 0.128 for the Scottish-Swedish model. In an Italian cohort of asymptomatic T1D adults, T1D-specific risk scores demonstrated a strong discrimination ability for imaging-defined subclinical atherosclerosis. They might help triage asymptomatic individuals who could benefit from targeted cardiovascular imaging in specific settings. Since these tools predict events rather than imaging findings, recalibration and prospective validation against imaging endpoints are needed before using predicted probabilities as absolute risks informing clinical decision‑making. ClinicalTrials.gov Identifier: NCT06290544. Registered on 4 March 2024.
Molinari et al. (Thu,) conducted a cross-sectional in Type 1 Diabetes (n=101). T1D-specific cardiovascular risk models (ST1RE and Scottish-Swedish risk score) was evaluated on Composite imaging endpoint (any coronary plaque on CCTA and/or maximum carotid intima-media thickness ≥1.5 mm) (AUC 0.899 (ST1RE) and 0.907 (Scottish-Swedish)). The ST1RE and Scottish-Swedish risk scores strongly discriminated imaging-defined subclinical atherosclerosis in asymptomatic adults with type 1 diabetes, with AUCs of 0.899 and 0.907, respectively.