The Steno Type 1 Risk Engine identifies preclinical atherosclerosis better than the ESC/EASD-2019 Guidelines in adult subjects with type 1 diabetes at high-risk

Objective: To evaluate the concordance between the ESC/EASD-2019 and the Steno Type 1 Risk Engine (Steno-Risk) cardiovascular risk scales in persons with type 1 diabetes (T1D) without cardiovascular disease (CVD), and to analyze their relationships with preclinical atherosclerosis. Research design and methods: We consecutively selected patients with T1D, without CVD, with: ≥40 years, nephropathy, or ≥10 years of evolution with another risk factor. The presence of plaque at different carotid segments was determined by ultrasonography. Cardiovascular risk was estimated according to ESC/EASD-2019 risk groups (moderate/high/very-high) and the Steno-Risk ( Results: We included 501 patients (53% males, age 48.8 years, T1D duration 26.5 years, 41.3% harboring plaques). Concordance between T1D-specific scales was poor (kappa= 0.19). A stepped increase in the presence of plaques according to the Steno-Risk category was seen (18.4%, 38.2% and 64.1%, for low/moderate/high-risk; p for trend Conclusions: In T1D patient undergoing primary prevention, Steno-Risk seems to better recognize individuals with atherosclerosis in comparison to ESC/EASD-2019. Notwithstanding, carotid ultrasound could improve the categorization of cardiovascular risk.