Steno type 1 risk engine and preclinical atherosclerosis in Mediterranean individuals with type 1 diabetes

Background and aims Tools to detect type 1 diabetes (T1D) individuals at overt cardiovascular disease (CVD) risk are scarce. We aimed to assess the usefulness of the score 'Steno Type 1 Risk Engine' (Steno-Risk) to identify T1D patients with advanced carotid atherosclerosis. Material and methods T1D patients without CVD with at least one of the following were included: >= 40 years, diabetic nephropathy, or diabetes duration >= 10 years with >= 1 CVD risk factor. Intima-media thickness (IMT) and plaque presence (IMT >= 1.5 mm) were assessed by standardized B-mode ultrasonography. Steno-Risk was used to estimate 10-year risk (<10% low; 10%-20% moderate; >= 20% high risk). Associations between Steno-Risk and preclinical atherosclerosis were assessed after adjusting for other CVD risk factors. Results We evaluated 302 patients (55% men, age 47.8 +/- 9.8 years, T1D duration 26.3 +/- 9.3 years). The prevalence of carotid plaque and >= 2 plaques were 36.4% and 19.2%, respectively; without sex differences. Age (57.4 +/- 7.4 vs 37.1 +/- 6.2 years), T1D duration (31.3 +/- 10.4 vs 21.5 +/- 7.1 years), hypertension (52.3% vs 6.3%), nephropathy (25.6% vs 5.1%) and retinopathy (53.5% vs 32.9%) were higher in high-risk (n = 86) vs low-risk participants (n = 79; P < .001 for all). Preclinical atherosclerosis (IMT and plaque) increased in parallel with Steno-Risk (P < .001). In logistic regression analysis, both age >= 40 years and Steno-Risk >= 20% were associated with the presence of plaque (OR 4.22 [1.57-11.36] and 3.79 [1.61-6.80]; respectively), but only high Steno-Risk remained independently associated with >= 2 plaques (OR 3.31 [1.61-6.80]). Conclusion Steno-Risk is independently associated with preclinical atherosclerosis. Further studies are needed to ascertain its usefulness in this high-risk population.