Risk Factors for T1D & Cardiovascular Disease
by IDS Director of Intensive Diabetes Management, Tavia Vital
The answer to “What´s My Risk?” can be found in a new summary article titled ‘Call to Action’: Greater CVD Focus Urged for Type 1 Diabetes by Miriam Tucker. At the European Association for the Study of Diabetes (EASD) 2024 Annual Meeting, summaries were provided that indicate the risk may be greater than many people are aware of.
Dr. Rebecka Johanna Bergdal, while presenting, urged a “call to action” to healthcare workers to ensure they do their utmost to “continue supporting and encouraging individuals with T1D towards better management of diabetes, including both glucose and lipid management.”
The session moderator, Dr. Krzysztof Strojeck, MD, PhD, advised to not only look at A1C but all Cardiovascular Disease (CVD) related risk factors. Research presented from the Czech Republic, Sweden, France, and Scotland outlined the contributing factors to a higher risk for CVD and Coronary Artery Disease (CAD) in people living with T1D.
- Time spent with an A1C above 7%
- Smoking
- Overweight or Obesity
- Elevated or borderline LDL cholesterol and Lipoprotein (a) levels
- Longstanding T1D or diagnosed with T1D after age 40
A study from the Czech Republic reviewed data from 62 people with T1D who had no symptoms of CVD, an average of 36 years of T1D, an Average A1C of 7.5%, and no history of CVD, found nearly 20% of the participants had an elevated coronary artery calcium (CAC) score of over 400!
A CAC score over 100 warrants further evaluation and typically statin therapy initiation as well as other steps to reduce risk factors. Of those who had a CAC of over 400, 42% had obstructive CAD which correlated well with findings of the more invasive method of coronary angiogram that was also done as part of the study. This subgroup needed a very high-risk treatment plan initiated immediately due to several identified high risks for plaque rupture at several sites across their vasculature.
- The study physicians noted that the people with T1D with the high CAC scores looked overall healthy, did not have any symptoms of CVD, were not of advanced age, and had borderline cholesterol scores that typically do not receive attention and would not have been screened with a CAC test as a standard part of their regular care if they were not participating in the research study.
- The study presented from Sweden reviewed data from 10,184 people with T1D, 375,523 people with T2D, and 509,172 people without a diagnosis of diabetes. The data from people living with T1D was stratified by age at diagnosis of 18-29, 30-39, and greater than 40. People with T1D who smoke, have greater time with A1c above target, or with a Body Mass Index (BMI) in the overweight or obese category had the highest risks for CVD and contributed strongly to major adverse cardiovascular events (MACE) such as heart attack or stroke. Though the study found a lower incidence of CVD in people living with T1D than those living with T2D, the incidence was higher than in the population of people without any diabetes diagnosis.
Two studies from France and one from Scotland found a 10-year CVD risk was higher for those living with T1D and overweight (9.61%) or obese (9.93%) compared to those with normal BMI (7.24%). In the groups living with overweight or obesity, the average LDL and triglyceride cholesterols were higher, and they had significantly higher odds of developing arterial hypertension. Importantly, MACE was more common among those living with overweight or obesity and T1D with a much higher risk for acute myocardial infarction (heart attack) than the normal BMI group.
There is now more clear evidence than ever before that people living with T1D need early CVD screening and evaluation, risk reduction, and treatment planning throughout the life span. Do not delay if you have any family or personal history of CVD such as high LDL or triglycerides, high blood pressure (even if managed with cholesterol or blood pressure medications), if you smoke, if you do not get regular physical activity if you seldom eat non-starchy veggies or tend to eat out or “to go” frequently.
Ask your family physician, Endocrinologist, or Cardiologist for a Coronary Artery Calcium test (sometimes called a Calcium CT Score). If you have lived with T1D for more than 10 years, are an adult, and have not had a CAC, now is the best time to discuss this screening test with your healthcare team.
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