Performance of the Steno type 1 risk engine for cardiovascular disease prediction in Italian patients with type 1 diabetes |
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| Institution: | 1. Department of Medicine, University of Padova, 35128 Padova, Italy;2. Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128, Padova, Italy;3. Independent Statistician, Solagna, Italy;4. Veneto Institute of Molecular Medicine, 35128 Padova, Italy;1. College of Health Sciences Vin University Hanoi, Viet Nam;2. Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Italy;3. Department of Preventive Medical Science, University of Naples Federico II, Italy;1. Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China;2. Tongzhou Maternal and Child Health Hospital of Beijing, 101101, China;3. Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China;1. Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China;2. Department of Nutrition, the Second Hospital of Tianjin Medical University, Tianjin, China;3. Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, China;4. Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China;5. College of Pharmacy, Tianjin Medical University, Tianjin 300070, China;6. Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China;7. Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China;1. Department of Laboratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University & Yuying Children''s Hospital, Wenzhou, China;2. NAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China;3. Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China;4. Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China;5. Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China;6. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy;7. Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Southampton, UK;8. Institute of Hepatology, Wenzhou Medical University, Wenzhou, China;9. The Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China;1. Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, Australia;2. Twins Research Australia, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, Australia;3. Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia;4. Adelaide Medical School, Robinson Research Institute, University of Adelaide, Australia;5. Murdoch Children''s Research Institute, Parkville, Australia;6. Centre for Molecular and Medical Research, School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia;1. Hangzhou Aeronautical Sanatorium of Chinese Air Force, Hangzhou, China;2. Department of Rheumatology, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China;3. Department of Endocrinology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, China;4. Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, China;5. Department of Endocriology, Punan Hospital of Pudong New District, Shanghai, China;6. Department of Traffic Management Engineering, Zhejiang Police College, Hangzhou, China |
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| Abstract: | Background and aimsPremature cardiovascular disease cause excess mortality in type 1 diabetes (T1D). The Steno T1D Risk Engine was developed and validated in northern European countries but its validity in other populations is unknown. We evaluated the performance of the Steno T1D Risk Engine in Italian patients with T1D.Materials and methodsWe included patients with T1D with a baseline visit between July 2013 and April 2014, who were free of cardiovascular disease and had complete information to estimate risk. The estimated cardiovascular risk score was compared with the 5-year rate of cardiovascular events by means of logistic regression.ResultsAmong 223 patients (mean age 43 ± 13 years, 34.5% male, mean duration of diabetes 22 ± 12 years) the mean estimated cardiovascular risk at 5 years was 5.9% (95% C.I. 5.2–6.5%). At baseline, high estimated risk discriminated the presence of asymptomatic atherosclerosis better than microangiopathy, and was not associated with markers of inflammation or endothelial activation. After a mean follow-up of 4.7 ± 0.5 years, only 3 cardiovascular events were observed and nonetheless the risk score was significantly associated with their incidence (OR 1.22; 95% C.I. 1.08–1.39, p = 0.001). However, the observed event rate was significantly lower than the estimated one (3 vs 13; 95% C.I. 12–14; p < 0.001).ConclusionThe Steno T1D Risk Score identified subjects with subclinical atherosclerosis and high cardiovascular risk in an Italian T1D population. However, the absolute risk was significantly overestimated. Further studies in larger population are needed to confirm these results. |
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| Keywords: | Observational Risk prediction Stratification Score |
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