11/10/2023 0 Comments My life playsets![]() A standardized mortality ratio of up to 39-fold has been reported in patients with T1DM and significant renal disease. While features such as the presence of nephropathy or retinopathy identify higher risk groups, the use of other biomarkers of risk and indeed the indication for enhanced treatment is often not appreciated. The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recently updated their position statement on the management of type 2 diabetes (T2DM) in adults, to include additional focus on cardiovascular risk factor management. ![]() A similar approach in T1DM seems entirely reasonable. Improved management of traditional cardiovascular risk factors has led to remarkable improvements in survival, with a 29% reduction in the relative risk of death over a 10-year period, such that the overall relative risk for CVD is now 2.3 for men and 3.0 for women. This relative risk was previously reported as being 3.6 in men and 7.7 in women. The excess relative risk in women with T1DM is not explained by changes in known cardiovascular risk factors. In contrast to the general population therefore, female sex should not be considered to offer protection against CVD. It is important that clinicians recognise that men and women with T1DM now have a similar absolute risk of CVD. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. In an analysis of the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study baseline glycated haemoglobin (HbA1c), duration of diabetes, lower insulin doses, impaired renal function, increased albumin excretion, higher diastolic BP and lipid profile were all predictive of CVD. The Steno Type 1 Risk Engine for the prediction of a first cardiovascular event in T1DM includes ten risk factors: age, sex, diabetes duration and HbA1c, systolic BP, low-density lipoprotein (LDL) cholesterol, glomerular filtration rate and albuminuria, and smoking and exercise. Development of T1DM before 10 years of age is associated with a 30-fold increased risk of CVD in early adulthood women with onset of T1DM before 10 years of age have a 90-fold increased risk of acute myocardial infarction over the same period.Īge appears to be by far the most significant factor, followed by time-weighted mean HbA1c. Hyperglycaemia appears to have a more profound effect on cardiovascular risk in T1DM than T2DM.
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