August 18, 2025Journal of Diabetes and its Complications1 citationsOpen Access
View Full PaperBurden and progression of arterial calcification in type 1 diabetes predicts future cardiovascular disease
Key Result
Baseline coronary artery calcium score > 10 was associated with an increased risk of major adverse cardiovascular events in persons with type 1 diabetes without kidney disease (p=0.04).
Study Design
Type
Cohort (n=75)
Structured PICO
Does increased coronary artery calcium score predict future major adverse cardiovascular events in persons with type 1 diabetes without kidney disease?
P
Population
75 persons with type 1 diabetes without kidney disease, evaluated for arterial calcification and followed for a median of 12.4 years.
E
Exposure
CT evaluation of coronary artery calcium score (CACS > 10), progression of coronary artery calcium, and generalised arterial calcification
C
Comparator
CACS ≤ 10 or no progression
O
Outcome
Major adverse CV events (MACE) defined as CV-death, ischemic heart disease, heart failure, stroke, coronary interventions, and/or peripheral artery interventioncomposite
Increased coronary artery calcium score (CACS > 10) predicts future major adverse cardiovascular events in patients with long-term type 1 diabetes without kidney disease, suggesting a role for CACS in individualized CV risk management.
Main Result
p-value: p=0.04
Abstract
AIMS: Even in the absence of kidney disease in persons with type 1 diabetes, there is an increased risk of cardiovascular (CV) disease through mechanisms not fully understood. This study aims to investigate whether evaluating arterial calcification can augment CV risk stratification in people with type 1 diabetes. METHODS: Persons with type 1 diabetes included in previous studies evaluating subclinical CV disease with CT scans of arterial beds in 75 persons without kidney disease were assessed for major adverse CV events (MACE) defined as CV-death, ischemic heart disease, heart failure, stroke, coronary interventions, and/or peripheral artery intervention. CT allowed for evaluation of coronary artery calcium score (CACS), progression of coronary artery calcium and generalised arterial calcification in multiple arterial beds. Cox regression was used for survival analyses. RESULTS: Seventy-three persons were available for endpoint evaluation and 16 (22 %) experienced a MACE after a median follow-up of 12.4 years (IQR 9.1-12.8). In unadjusted analyses, MACE was associated with baseline CACS > 10 (p = 0.003), progression of coronary artery calcium (p = 0.03) and generalised arterial calcification (p = 0.006). After adjustment for diabetes duration, baseline CACS > 10 remained associated with increased risk of MACE (p = 0.04). CONCLUSIONS: This study shows that increased CACS entails increased risk of future MACE in persons with type 1 diabetes without kidney- or prior CV disease. This finding suggests that CACS evaluation may help differentiate CV risk management in persons with long-term type 1 diabetes without evidence of kidney disease and thus may be another step towards individualised medicine.