Lifetime and 10-year cardiovascular risk prediction in individuals with type 1 diabetes: The LIFE-T1D model

Marga A G Helmink; Steven H J Hageman; Björn Eliasson; Naveed Sattar; Frank L J Visseren; Jannick A N Dorresteijn; Katie Harris; Sanne A E Peters; Mark Woodward; Péter Szentkúti; Kurt Højlund; Jan Erik Henriksen; Henrik Toft Sørensen; Erik H Serné; Thomas T van Sloten; Reimar W Thomsen; Jan Westerink

doi:10.1111/dom.15531

Lifetime and 10-year cardiovascular risk prediction in individuals with type 1 diabetes: The LIFE-T1D model

Marga A G Helmink, Steven H J Hageman, Björn Eliasson, Naveed Sattar, Frank L J Visseren^*, Jannick A N Dorresteijn, Katie Harris, Sanne A E Peters, Mark Woodward, Péter Szentkúti, Kurt Højlund, Jan Erik Henriksen, Henrik Toft Sørensen, Erik H Serné, Thomas T van Sloten, Reimar W Thomsen, Jan Westerink

^*Corresponding author for this work

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Abstract

AIMS: To develop and externally validate the LIFE-T1D model for the estimation of lifetime and 10-year risk of cardiovascular disease (CVD) in individuals with type 1 diabetes.

MATERIALS AND METHODS: A sex-specific competing risk-adjusted Cox proportional hazards model was derived in individuals with type 1 diabetes without prior CVD from the Swedish National Diabetes Register (NDR), using age as the time axis. Predictors included age at diabetes onset, smoking status, body mass index, systolic blood pressure, glycated haemoglobin level, estimated glomerular filtration rate, non-high-density lipoprotein cholesterol, albuminuria and retinopathy. The model was externally validated in the Danish Funen Diabetes Database (FDDB) and the UK Biobank.

RESULTS: During a median follow-up of 11.8 years (interquartile interval 6.1-17.1 years), 4608 CVD events and 1316 non-CVD deaths were observed in the NDR (n = 39 756). The internal validation c-statistic was 0.85 (95% confidence interval [CI] 0.84-0.85) and the external validation c-statistics were 0.77 (95% CI 0.74-0.81) for the FDDB (n = 2709) and 0.73 (95% CI 0.70-0.77) for the UK Biobank (n = 1022). Predicted risks were consistent with the observed incidence in the derivation and both validation cohorts.

CONCLUSIONS: The LIFE-T1D model can estimate lifetime risk of CVD and CVD-free life expectancy in individuals with type 1 diabetes without previous CVD. This model can facilitate individualized CVD prevention among individuals with type 1 diabetes. Validation in additional cohorts will improve future clinical implementation.

Original language	English
Pages (from-to)	2229-2238
Number of pages	10
Journal	Diabetes, Obesity & Metabolism
Volume	26
Issue number	6
Early online date	8 Mar 2024
DOIs	https://doi.org/10.1111/dom.15531
Publication status	Published - Jun 2024

Keywords

cardiovascular disease
diabetes complications
macrovascular disease
type 1 diabetes

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Diabetes Obesity Metabolism - 2024 - Helmink - Lifetime and 10‐year cardiovascular risk prediction in individuals with typeFinal published version, 1.57 MBLicence: CC BY-NC

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Helmink, M. A. G., Hageman, S. H. J., Eliasson, B., Sattar, N., Visseren, F. L. J., Dorresteijn, J. A. N., Harris, K., Peters, S. A. E., Woodward, M., Szentkúti, P., Højlund, K., Henriksen, J. E., Sørensen, H. T., Serné, E. H., van Sloten, T. T., Thomsen, R. W., & Westerink, J. (2024). Lifetime and 10-year cardiovascular risk prediction in individuals with type 1 diabetes: The LIFE-T1D model. Diabetes, Obesity & Metabolism, 26(6), 2229-2238. https://doi.org/10.1111/dom.15531

@article{32281c3aa919456fbd79fdd00285d128,

title = "Lifetime and 10-year cardiovascular risk prediction in individuals with type 1 diabetes: The LIFE-T1D model",

abstract = "AIMS: To develop and externally validate the LIFE-T1D model for the estimation of lifetime and 10-year risk of cardiovascular disease (CVD) in individuals with type 1 diabetes.MATERIALS AND METHODS: A sex-specific competing risk-adjusted Cox proportional hazards model was derived in individuals with type 1 diabetes without prior CVD from the Swedish National Diabetes Register (NDR), using age as the time axis. Predictors included age at diabetes onset, smoking status, body mass index, systolic blood pressure, glycated haemoglobin level, estimated glomerular filtration rate, non-high-density lipoprotein cholesterol, albuminuria and retinopathy. The model was externally validated in the Danish Funen Diabetes Database (FDDB) and the UK Biobank.RESULTS: During a median follow-up of 11.8 years (interquartile interval 6.1-17.1 years), 4608 CVD events and 1316 non-CVD deaths were observed in the NDR (n = 39 756). The internal validation c-statistic was 0.85 (95% confidence interval [CI] 0.84-0.85) and the external validation c-statistics were 0.77 (95% CI 0.74-0.81) for the FDDB (n = 2709) and 0.73 (95% CI 0.70-0.77) for the UK Biobank (n = 1022). Predicted risks were consistent with the observed incidence in the derivation and both validation cohorts.CONCLUSIONS: The LIFE-T1D model can estimate lifetime risk of CVD and CVD-free life expectancy in individuals with type 1 diabetes without previous CVD. This model can facilitate individualized CVD prevention among individuals with type 1 diabetes. Validation in additional cohorts will improve future clinical implementation.",

keywords = "cardiovascular disease, diabetes complications, macrovascular disease, type 1 diabetes",

author = "Helmink, {Marga A G} and Hageman, {Steven H J} and Bj{\"o}rn Eliasson and Naveed Sattar and Visseren, {Frank L J} and Dorresteijn, {Jannick A N} and Katie Harris and Peters, {Sanne A E} and Mark Woodward and P{\'e}ter Szentk{\'u}ti and Kurt H{\o}jlund and Henriksen, {Jan Erik} and S{\o}rensen, {Henrik Toft} and Sern{\'e}, {Erik H} and {van Sloten}, {Thomas T} and Thomsen, {Reimar W} and Jan Westerink",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.",

year = "2024",

month = jun,

doi = "10.1111/dom.15531",

language = "English",

volume = "26",

pages = "2229--2238",

journal = "Diabetes, Obesity & Metabolism",

issn = "1462-8902",

publisher = "Wiley-Blackwell",

number = "6",

}

Helmink, MAG, Hageman, SHJ, Eliasson, B, Sattar, N, Visseren, FLJ , Dorresteijn, JAN, Harris, K, Peters, SAE, Woodward, M, Szentkúti, P, Højlund, K, Henriksen, JE, Sørensen, HT, Serné, EH, van Sloten, TT, Thomsen, RW & Westerink, J 2024, 'Lifetime and 10-year cardiovascular risk prediction in individuals with type 1 diabetes: The LIFE-T1D model', Diabetes, Obesity & Metabolism, vol. 26, no. 6, pp. 2229-2238. https://doi.org/10.1111/dom.15531

TY - JOUR

T1 - Lifetime and 10-year cardiovascular risk prediction in individuals with type 1 diabetes

T2 - The LIFE-T1D model

AU - Helmink, Marga A G

AU - Hageman, Steven H J

AU - Eliasson, Björn

AU - Sattar, Naveed

AU - Visseren, Frank L J

AU - Dorresteijn, Jannick A N

AU - Harris, Katie

AU - Peters, Sanne A E

AU - Woodward, Mark

AU - Szentkúti, Péter

AU - Højlund, Kurt

AU - Henriksen, Jan Erik

AU - Sørensen, Henrik Toft

AU - Serné, Erik H

AU - van Sloten, Thomas T

AU - Thomsen, Reimar W

AU - Westerink, Jan

PY - 2024/6

Y1 - 2024/6

N2 - AIMS: To develop and externally validate the LIFE-T1D model for the estimation of lifetime and 10-year risk of cardiovascular disease (CVD) in individuals with type 1 diabetes.MATERIALS AND METHODS: A sex-specific competing risk-adjusted Cox proportional hazards model was derived in individuals with type 1 diabetes without prior CVD from the Swedish National Diabetes Register (NDR), using age as the time axis. Predictors included age at diabetes onset, smoking status, body mass index, systolic blood pressure, glycated haemoglobin level, estimated glomerular filtration rate, non-high-density lipoprotein cholesterol, albuminuria and retinopathy. The model was externally validated in the Danish Funen Diabetes Database (FDDB) and the UK Biobank.RESULTS: During a median follow-up of 11.8 years (interquartile interval 6.1-17.1 years), 4608 CVD events and 1316 non-CVD deaths were observed in the NDR (n = 39 756). The internal validation c-statistic was 0.85 (95% confidence interval [CI] 0.84-0.85) and the external validation c-statistics were 0.77 (95% CI 0.74-0.81) for the FDDB (n = 2709) and 0.73 (95% CI 0.70-0.77) for the UK Biobank (n = 1022). Predicted risks were consistent with the observed incidence in the derivation and both validation cohorts.CONCLUSIONS: The LIFE-T1D model can estimate lifetime risk of CVD and CVD-free life expectancy in individuals with type 1 diabetes without previous CVD. This model can facilitate individualized CVD prevention among individuals with type 1 diabetes. Validation in additional cohorts will improve future clinical implementation.

AB - AIMS: To develop and externally validate the LIFE-T1D model for the estimation of lifetime and 10-year risk of cardiovascular disease (CVD) in individuals with type 1 diabetes.MATERIALS AND METHODS: A sex-specific competing risk-adjusted Cox proportional hazards model was derived in individuals with type 1 diabetes without prior CVD from the Swedish National Diabetes Register (NDR), using age as the time axis. Predictors included age at diabetes onset, smoking status, body mass index, systolic blood pressure, glycated haemoglobin level, estimated glomerular filtration rate, non-high-density lipoprotein cholesterol, albuminuria and retinopathy. The model was externally validated in the Danish Funen Diabetes Database (FDDB) and the UK Biobank.RESULTS: During a median follow-up of 11.8 years (interquartile interval 6.1-17.1 years), 4608 CVD events and 1316 non-CVD deaths were observed in the NDR (n = 39 756). The internal validation c-statistic was 0.85 (95% confidence interval [CI] 0.84-0.85) and the external validation c-statistics were 0.77 (95% CI 0.74-0.81) for the FDDB (n = 2709) and 0.73 (95% CI 0.70-0.77) for the UK Biobank (n = 1022). Predicted risks were consistent with the observed incidence in the derivation and both validation cohorts.CONCLUSIONS: The LIFE-T1D model can estimate lifetime risk of CVD and CVD-free life expectancy in individuals with type 1 diabetes without previous CVD. This model can facilitate individualized CVD prevention among individuals with type 1 diabetes. Validation in additional cohorts will improve future clinical implementation.

KW - cardiovascular disease

KW - diabetes complications

KW - macrovascular disease

KW - type 1 diabetes

UR - http://www.scopus.com/inward/record.url?scp=85187114003&partnerID=8YFLogxK

U2 - 10.1111/dom.15531

DO - 10.1111/dom.15531

M3 - Article

C2 - 38456579

SN - 1462-8902

VL - 26

SP - 2229

EP - 2238

JO - Diabetes, Obesity & Metabolism

JF - Diabetes, Obesity & Metabolism

IS - 6

ER -

Lifetime and 10-year cardiovascular risk prediction in individuals with type 1 diabetes: The LIFE-T1D model

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