How to improve cardiovascular risk assessment in type 1 diabetes? The role of vascular age and arterial stiffness

Introduction Cardiovascular disease is the leading cause of mortality in individuals with type 1 diabetes mellitus (T1DM). Traditional cardiovascular risk (CVR) models may underestimate risk in this population, especially in high-risk countries. Vascular age (VA) and arterial stiffness (AS) are emerging as potential markers for improving CVR assessment. Objectives This study investigated the association between VA, AS, and the modified steno type 1 risk engine (ST1RE) score in adults with T1DM. Patients and Methods We included 109 T1DM adults, aged 18-50 years, with at least five years of disease duration. None had been diagnosed with cardiovascular disease or hypertension. VA was calculated using carotid intima-media thickness (cIMT), while AS was assessed by 24-hour measurement of aortic pulse wave velocity (PWV). We compared the standard ST1RE score, based on chronological age, with a modified ST1RE score based on VA. Results Study participants had a median age of 32.4 (25.5-38.6) years and a diabetes duration of 14.0 (10.0-20.0) years. Using VA in the modified ST1RE score reclassified 32.1% of participants into a higher CVR category. The median CVR for the modified ST1RE was 9.68 (4.61-20.08)%, compared to 4.74 (3.24-8.12)% using the standard score. The modified ST1RE score was positively associated with PWV, OR 2.37 (95% CI: 1.46-3.84) P = 0.004, adjusting for sex, BMI, and at least one diabetic complication. Conclusions Implementing VA and AS in clinical practice could enhance risk assessment in T1DM individuals, especially in high-risk populations. Further validation in larger cohorts is necessary.