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Carotid ultrasonography as a strategy to optimize cardiovascular risk management in type 1 diabetes: a cohort study

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Abstract

Background and aims

Although cardiovascular disease (CVD) remains the leading cause of mortality in type 1 diabetes (T1D), the use of cardioprotective drugs is scarce. We aimed to evaluate the impact of carotid ultrasonography (US) on the improvement in cardiovascular risk factors (CVRFs) in T1D.

Methods and results

T1D patients without CVD meeting criteria for lipid treatment according to guidelines (age ≥ 40 years, nephropathy and/or ≥ 10 years of diabetes duration with ≥ 1 additional CVRFs) were included. The carotid-US group (US-G) underwent a standardized US protocol and CVRF assessment; recommendations were made according to subclinical atherosclerosis status. The control group (CG) followed usual clinical practice. Changes in CVRFs, specially statin use and LDL cholesterol levels, at 1 year were analysed.

A total of 318 patients were included (51.3% female, mean age of 49.1 years and 25.5 years of diabetes duration): 211 in the US-G and 107 in the CG. Participants in the US-G had a higher baseline LDL cholesterol than controls (114 vs. 102 mg/dL; p < 0.001). Lipid-lowering treatment was modified in 38.9% in the US-G and 6.5% in the CG (p < 0.001). At 1 year, the US-G was more frequently on statins, had lower LDL cholesterol and 27% had stopped smoking (p < 0.001 for all). Changes were more pronounced in those with plaques (p < 0.001). In multivariate analyses adjusted for age, sex and other CVRFs, belonging to the US-G was independently associated with the intensification of lipid-lowering treatment (OR 10.47 [4.06–27.01]). Propensity score-matching analysis yielded similar results (OR 20.09 [7.86–51.37]).

Conclusion

Carotid-US is independently associated with an intensification of lipid-lowering therapy in a high-risk T1D population.

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Data availability

The data sets used during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

A.J.A. received a research grant (“Ajut per a la recerca en diabetis modalitat clínica 2018”) from the Associació Catalana de Diabetis (ACD). L.B received a research grant (Resident Award “Premi Fi de Residènica Emili Letang” 2019) from Hospital Clínic de Barcelona, Research, Innovation and Education Department and a research grant (“Ajut ACD per la realització del programa de doctorat 2020”) from ACD.

Funding

No specific funding was received.

Author information

Authors and Affiliations

  1. Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain

    Laura Boswell, Tonet Serés-Noriega, Alex Mesa, Adriana Pané & Clara Viñals

  2. Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain

    Laura Boswell, Alex Mesa, Jesús Blanco, Marga Giménez, Enric Esmatjes & Ignacio Conget

  3. Endocrinology and Nutrition Department, Althaia University Health Network, Manresa, Spain

    Laura Boswell

  4. Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain

    Verónica Perea

  5. Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain

    Adriana Pané

  6. Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain

    Jesús Blanco, Marga Giménez, Irene Vinagre, Enric Esmatjes, Ignacio Conget & Antonio J. Amor

  7. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Carlos III Health Institute, Madrid, Spain

    Marga Giménez, Enric Esmatjes & Ignacio Conget

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  1. Laura Boswell
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Contributions

LB, TS, AM, VP, AP, CV, MG, IV, JB, EE, IC and AJA acquired and processed all clinical data. AJA performed the US measurements. LB, AJA and IC contributed to the study concept and design. All authors participated in data analysis and interpretation and reviewed the final version of the manuscript. LB and AJA wrote the manuscript, designed the figures and had final responsibility for the decision to submit for publication. LB and AJA are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding authors

Correspondence to Laura Boswell or Antonio J. Amor.

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The authors declare that they have no competing interests.

Ethical standard

The study protocol was reviewed and approved by the Hospital Clínic de Barcelona's Research Ethics Committe (approval code: HCB/2020/0195). All procedures performed in the studies involving human participants were in accordance with ethical standars of the institutional research committe and with the 1964 Helsinki declarationand its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants included in the study.

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Boswell, L., Serés-Noriega, T., Mesa, A. et al. Carotid ultrasonography as a strategy to optimize cardiovascular risk management in type 1 diabetes: a cohort study. Acta Diabetol 59, 1563–1574 (2022). https://doi.org/10.1007/s00592-022-01959-z

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