Risk Model May Estimate Lifetime CVD Risk Among Patients With T1D

While the 10-year cardiovascular risk is low among young patients with type 1 diabetes, their lifetime risk is substantial.

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Researchers have developed a tool they say can help provide early identification of people with type 1 diabetes (T1D) who would benefit from preventive measures against heart disease, a disease that carries an elevated risk among patients with the condition.

The tool, dubbed the LIFE-T1D model, demonstrated an ability to estimate the lifetime risk of cardiovascular disease (CVD) among several groups of people with T1D. The model offers an advantage over previous validated models, say the researchers, by providing lifetime risk estimates. Previous models relied on shorter term prediction horizons of up to 10 years.

"As type 1 diabetes is a near-lifelong disease, with the majority of patients being diagnosed before the age of 30 years, very long-term estimates may be more informative when discussing and individualizing risk and benefit in individuals with type 1 diabetes,” detailed the group.

While a 10-year CVD risk in a young patient may be low, the risk of CVD increases with age, meaning the lifetime risk in these individuals may be "substantial."

"Lifetime risk estimates may underscore the necessity of early and sustained management of modifiable cardiovascular risk factors, even when short-term risk appears negligible," they wrote.

The LIFE-T1D model was created based on data from 39,000 Swedish people with T1D and no history of CVD, and it relies on easily captured measures from outpatient clinics and patient electronic records, including age at diabetes onset, smoking status, and systolic blood pressure. Among individuals aged under 40 years, median lifetime risk of CVD was 69.4% and among individuals aged 40 years and older, median lifetime risk was 76%.

Over a median follow-up of nearly 12 years, 4600 CVD events and 1200 nonvascular deaths occurred among the cohort. Internal validation c-statistics were 0.85 (95% CI; 0.84–0.86) for both males and females. There were 2 sex-specific models created in order to account for differences in the relative effects of predictors and risks, including smoking, that differ between sexes.

Two additional cohorts of people with T1D from low-risk regions—2700 from Denmark and 1000 from the United Kingdom—were used to externally validate the model. Among these groups, there were 168 and 155 CVD events over 8- and 12-year follow-up periods, respectively. Validation c-statistics were 0.77 (95% CI; 0.74–0.81) among the Danish patients and 0.73 (95% CI; 0.70–0.77) among the United Kingdom patients.

The model's basis on contemporary and representative data is one of its strengths, the researchers noted. The large study population also allows for accurate predictions and generalizability.

To broaden applicability of their model, the researchers suggest validation in more data sources, as well as higher risk regions. The group also noted that several factors associated with higher risk of CVD, such as socioeconomic status, were not taken into consideration.

Reference

Helmink M, Hageman S, Eliasson B, et al. Lifetime and 10-year cardiovascular risk prediction in individuals with type 1 diabetes: The LIFE-T1D model. Diabetes Obes Metab. Published online March 8, 2024. doi:10.1111/dom.15531