Cardiovascular Risk in Type 1 Diabetes Mellitus

Abstract

Type 1 diabetes mellitus (T1DM) is associated with premature cardiovascular disease (CVD), but the underlying mechanisms remain poorly understood. The American Diabetes Association and the European Association for the Study of Diabetes recently updated their position statement on the management of type 2 diabetes mellitus (T2DM) to include additional focus on cardiovascular risk; improved management of risk factors in T1DM is also needed. There are important differences in the pathophysiology of CVD in T1DM and T2DM. Hyperglycaemia appears to have a more profound effect on cardiovascular risk in T1DM than T2DM, and other risk factors appear to cause a synergistic rather than additive effect, so achievement of treatment targets for all recognized risk factors is crucial to reducing cardiovascular risk. Here we discuss the evidence for addressing established cardiovascular risk factors, candidate biomarkers and surrogate measurements, and possible interventions.

Keywords: Cardiovascular disease; Cardiovascular risk; Type 1 diabetes mellitus.

Fig. 1

Summary of mechanisms underlying cardiovascular disease in type 1 diabetes. Hyperglycaemia results in enhanced formation of AGEs and an adverse lipid profile with high levels of atherogenic IDL and dysfunctional HDL. There is a resultant impairment in reverse cholesterol transport and anti-inflammatory properties of HDL. Low insulin levels and hyperglycaemia further contribute to the systemic inflammatory process which is central to vascular endothelial dysfunction and atherosclerosis. AGE advanced glycation end products, HDL high-density lipoprotein, IDL intermediate-density lipoprotein, LDL low-density lipoprotein, oxLDL oxidised low-density lipoprotein, ROS reactive oxygen species

Fig. 2

Cardiovascular risk engines: Steno T1—https://steno.shinyapps.io/T1RiskEngine/; UKPDS—https://www.dtu.ox.ac.uk/riskengine/; QRISK3—https://qrisk.org/three/