2d97c23ebec058661d42cb88f1336eaa 329514.pdf f1c82c04568f9c7c338dfdc8dc3eb467f41ef396 329514.pdf 5c16690160d548fc7440f425d118c21b44b077ecffe9388ef9742597cfb69572 329514.pdf Title: Factors Involved in the Progression of Preclinical Atherosclerosis in People with Type 1 Diabetes Subject: Background/objectives: Individuals with type 1 diabetes (T1DM) face an elevated risk of cardiovascular disease (CVD), yet the factors driving atherosclerosis remain unclear. This study aimed to assess factors associated with preclinical atherosclerosis development or progression in T1DM. Methods: We conducted a prospective study in T1DM individuals without established CVD, aged 40 years, with diabetic kidney disease and/or 10 years of T1DM plus another cardiovascular risk factor (CVRF). Baseline evaluation followed a standardized CV risk assessment protocol, including carotid ultrasound and cardiovascular risk estimation using the Steno Type 1 Risk Engine (ST1RE). Ultrasound was repeated after 3–5 years; progression was defined as an increase in plaque number. CVRF control was considered optimal when LDL-cholesterol was within target based on atherosclerotic burden, blood pressure <130/80 mmHg, HbA1c <7%, and non-smoking status. Logistic regression models identified predictors of progression. Results: We included 151 participants (55.6% women; mean age 49.8 8.9 years; T1DM duration 27.3 9.1 years); 42.4% had plaques at baseline. Over a follow-up of 5.22 1.29 years, despite improved CVRF control (p < 0.05), 40.4% experienced progression. Older age (OR 1.38 [1.1–1.8]) and active smoking (OR 3.29 [1.4–7.5]) were significant predictors of progression. Baseline cardiovascular risk measured by the ST1RE independently predicted progression (OR 1.09 [1.03–1.15]) after adjusting for other CVRFs. Persistent smoking (OR 2.52 [1.06–5.99]) and baseline ST1RE (OR 1.06 [1.02–1.11]) remained significant after accounting for baseline and follow-up CVRFs. Conclusions: Despite improved CVRF control, atherosclerosis progression is common in T1D. ST1RE may help identify individuals at highest risk for targeted preventive strategies. Keywords: atherosclerosis; cardiovascular risk factors; carotid atherosclerosis; carotid ultrasound; Steno Type 1 Risk Engine; type 1 diabetes Author: Clara Viñals, Ignacio Conget, Montse Granados, Clara Solà, Denisse Ayala, Alex Mesa, Tonet Serés-Noriega, Mònica Domenech, Verónica Perea, Jesús Blanco, Irene Vinagre, Marga Giménez and Antonio J. Amor Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Tue Nov 11 03:52:17 2025 CET ModDate: Tue Nov 11 05:17:18 2025 CET Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1087216 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- SSJMKU+CMSY10 Type 1 Builtin yes yes yes 104 0 HQBQWV+VnURWPalladioL Type 1 Custom yes yes yes 105 0 QMWBJP+URWPalladioL-Bold Type 1 Custom yes yes yes 106 0 KGSVEK+VnURWPalladioL-Bold Type 1 Custom yes yes yes 107 0 MRPSQE+URWPalladioL-Roma Type 1 Custom yes yes yes 108 0 GRUPFT+URWPalladioL-Ital Type 1 Custom yes yes yes 109 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 210 0 NOMJID+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 219 0 NOMJIB+PalatinoLinotype TrueType WinAnsi yes yes no 220 0 NOMJID+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 227 0 NOMJIB+PalatinoLinotype TrueType WinAnsi yes yes no 228 0 NOMJID+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 263 0 NOMJIB+PalatinoLinotype TrueType WinAnsi yes yes no 264 0 NOMJHP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 265 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-07-04 04:33:28 CEST RepresentationInformation: 329514.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-07-03 09:47:51 CEST Size: 1087216 Format: PDF Version: 1.5 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 432 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Materials and Methods Children: Item: Title: Study Participants Item: Title: Clinical and Laboratory Measures Item: Title: Carotid B Ultrasound Imaging Item: Title: Cardiovascular Risk Assessment, Attainment of Cardiovascular Risk Factor Goals, and Follow-Up Item: Title: Statistical Analysis Item: Title: Results Children: Item: Title: Baseline Characteristics Associated with Atherosclerosis Progression Item: Title: Baseline Predictors of Atherosclerosis Progression Item: Title: Changes in Cardiovascular Risk Factors During the Follow-Up and Association with Atherosclerosis Progression Item: Title: Discussion Item: Title: References Info: Title: Factors Involved in the Progression of Preclinical Atherosclerosis in People with Type 1 Diabetes Author: Clara Viñals, Ignacio Conget, Montse Granados, Clara Solà, Denisse Ayala, Alex Mesa, Tonet Serés-Noriega, Mònica Domenech, Verónica Perea, Jesús Blanco, Irene Vinagre, Marga Giménez and Antonio J. Amor Subject: Background/objectives: Individuals with type 1 diabetes (T1DM) face an elevated risk of cardiovascular disease (CVD), yet the factors driving atherosclerosis remain unclear. This study aimed to assess factors associated with preclinical atherosclerosis development or progression in T1DM. Methods: We conducted a prospective study in T1DM individuals without established CVD, aged 40 years, with diabetic kidney disease and/or 10 years of T1DM plus another cardiovascular risk factor (CVRF). Baseline evaluation followed a standardized CV risk assessment protocol, including carotid ultrasound and cardiovascular risk estimation using the Steno Type 1 Risk Engine (ST1RE). Ultrasound was repeated after 3–5 years; progression was defined as an increase in plaque number. CVRF control was considered optimal when LDL-cholesterol was within target based on atherosclerotic burden, blood pressure <130/80 mmHg, HbA1c <7%, and non-smoking status. Logistic regression models identified predictors of progression. Results: We included 151 participants (55.6% women; mean age 49.8 8.9 years; T1DM duration 27.3 9.1 years); 42.4% had plaques at baseline. Over a follow-up of 5.22 1.29 years, despite improved CVRF control (p < 0.05), 40.4% experienced progression. Older age (OR 1.38 [1.1–1.8]) and active smoking (OR 3.29 [1.4–7.5]) were significant predictors of progression. Baseline cardiovascular risk measured by the ST1RE independently predicted progression (OR 1.09 [1.03–1.15]) after adjusting for other CVRFs. Persistent smoking (OR 2.52 [1.06–5.99]) and baseline ST1RE (OR 1.06 [1.02–1.11]) remained significant after accounting for baseline and follow-up CVRFs. Conclusions: Despite improved CVRF control, atherosclerosis progression is common in T1D. ST1RE may help identify individuals at highest risk for targeted preventive strategies. 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