American Diabetes Association
dc22-0118-File005.pdf (1.6 MB)

The Steno Type 1 Risk Engine identifies preclinical atherosclerosis better than the ESC/EASD-2019 Guidelines in adult subjects with type 1 diabetes at high-risk

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Version 2 2022-09-08, 14:29
Version 1 2022-08-09, 20:49
posted on 2022-09-08, 14:29 authored by Tonet Serés-Noriega, Marga Giménez, Verónica Perea, Laura Boswell, Clara Viñals, Jesús Blanco, Irene Vinagre, Adriana Pané, Enric Esmatjes, Ignacio Conget, Antonio J. Amor


Objective: To evaluate the concordance between the ESC/EASD-2019 and the Steno Type 1 Risk Engine (Steno-Risk) cardiovascular risk scales in persons with type 1 diabetes (T1D) without cardiovascular disease (CVD), and to analyze their relationships with preclinical atherosclerosis. 

Research design and methods: We consecutively selected patients with T1D, without CVD, with: ≥40 years, nephropathy, or ≥10 years of evolution with another risk factor. The presence of plaque at different carotid segments was determined by ultrasonography. Cardiovascular risk was estimated according to ESC/EASD-2019 risk groups (moderate/high/very-high) and the Steno-Risk (<10%, low; 10-20%, moderate; ≥20%, high), as T1D-specific scores. As an exploratory analysis, the non-T1D-specific ACC/AHA-2013 pooled cohort equation was also evaluated in individuals between 40-79 years.  

Results: We included 501 patients (53% males, age 48.8 years, T1D duration 26.5 years, 41.3% harboring plaques). Concordance between T1D-specific scales was poor (kappa= 0.19). A stepped increase in the presence of plaques according to the Steno-Risk category was seen (18.4%, 38.2% and 64.1%, for low/moderate/high-risk; p for trend<0.001), with no differences according to ESC/EASD-2019 (p=0.130). Steno-Risk identified individuals with plaques, unlike ESC/EASD-2019 (AUC=0.691; p<0.001 vs. AUC=0.538; p=0.149; respectively). Finally, in polynomial regression models (adjusted for lipid parameters and cardioprotective treatment), irrespective of the ESC/EASD-2019 category, high-risk by Steno-Risk was directly associated with atherosclerosis (in moderate/high-risk ESC/EASD-2019: OR 2.91 [1.27-6.72] and 5.290 [2.746-10.189], for the presence of plaque and ≥2 plaques, respectively). Similar results were obtained with discordant higher Steno-Risk vs. ACC/AHA-2013 (p<0.001). 

Conclusions: In T1D patient undergoing primary prevention, Steno-Risk seems to better recognize individuals with atherosclerosis in comparison to ESC/EASD-2019. Notwithstanding, carotid ultrasound could improve the categorization of cardiovascular risk. 


A.J.A received a research grant from the Associació Catalana de Diabetis (ACD), "Ajut per a la recerca en diabetis modalitat clínica 2018". We are also grateful to Donna Pringle for her helping in writing and editing the manuscript.


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