Abstract：
People living with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD), and it is the leading cause of morbidity and mortality in this population. CVD risk increases with each uncontrolled risk factor, even in individuals with good glycaemic control. Recommendations for assessing CVD risk in the T1D population are extended from those for type 2 diabetes (T2D) even though the physiopathology and underlying mechanisms of atherosclerosis in T1D are poorly understood and differ from those in T2D. Unlike the assessment of microvascular complications, which is well established in T1D, this is far from being the case for the comorbidities and risk associated with CVD. Aside from classical cardiovascular comorbidities, carotid ultrasound can be useful to stratify CVD risk. The utilization of specific risk scales such as the Steno Type 1 Risk Engine can help to more accurately classify cardiovascular risk in these individuals. The cornerstones of the management of cardiovascular risk in T1D are the promotion of the Mediterranean diet, tight glycaemic control (glycated haemoglobin (HbA1c) < 7%), blood pressure < 130/80 mmHg in most patients, and low-density lipoprotein (LDL) cholesterol < 100 mg/dL in moderate-risk individuals, < 70 mg/dL in high-risk individuals, and < 55 mg/dL in very high-risk individuals. Conventional medical follow-up of patients with T1D should be individualized (approximately 2-3 visits per year), and a carotid ultrasound evaluation is recommended every 5 years in the absence of significant preclinical atherosclerosis or more often in those with severe preclinical atherosclerosis. Antithrombotic therapy is recommended in those receiving secondary prevention, those with stenosis > 50% in any arterial bed, and those with an impaired ankle-brachial index. This document is a proposal of a practical approach for the evaluation, classification, and management of CVD risk in individuals living with T1D.
摘要：
患有1型糖尿病（T1D）的人患心血管疾病（CVD）的风险增加，它是这个人群发病和死亡的主要原因。CVD风险随着每个不受控制的风险因素而增加，即使是血糖控制良好的个体。尽管对T1D中动脉粥样硬化的病理生理学和潜在机制知之甚少，并且与T2D中的不同，但评估T1D人群中CVD风险的建议已从2型糖尿病（T2D）的建议扩展到扩展。与微血管并发症的评估不同，这在T1D中很好地确立了，与CVD相关的合并症和风险远非如此.除了经典的心血管合并症，颈动脉超声可用于对CVD风险进行分层。利用特定风险量表（如StenoType1风险引擎）可以帮助更准确地对这些个体的心血管风险进行分类。T1D心血管风险管理的基石是促进地中海饮食，严格的血糖控制（糖化血红蛋白（HbA1c）<7％），大多数患者的血压<130/80mmHg，和低密度脂蛋白（LDL）胆固醇<100mg/dL的中等风险个体，高危人群<70mg/dL，和<55mg/dL在极高危个体。T1D患者的常规医学随访应个体化（每年约2-3次），在没有明显临床前动脉粥样硬化的情况下,建议每5年进行一次颈动脉超声检查,或在严重临床前动脉粥样硬化的患者中更常见.在接受二级预防的患者中推荐抗血栓治疗，在任何动脉床中狭窄>50%的人，以及踝臂指数受损的人.本文件是评估的实用方法的建议，分类，以及T1D患者心血管疾病风险的管理。
