CVD risk in diabetes type 1 or type 2: more of the same, or very different?

The American Heart Association (AHA) and the American Diabetes Association (ADA) published a scientific statement in which they review the current insights on the underlying pathophysiology of the cardiovascular disease (CVD) risk of patients with type 1 diabetes (T1DM). In contrast to T2DM, relatively little is know about the relationship between T1DM and CVD risk factors.

Management approaches for CVD reduction in T1DM have largely been extrapolated from experience in T2DM. CVD in T1DM may, however, not be the same entity as in T2DM. Neither may risk factors for CVD be the same. There is an increasing need to better understand CVD in T1DM.
This Scientific Statement summarises recent observations of potential differences in the pathophysiology of T1DM and T2DM, and how these differences may affect the treatment of CVD risk factors in T1DM patients is explored. The epidemiology of different types of CVD in T1DM is summarised, as well as the specifics of CVD in special T1DM populations, like pregnant women and children.

Specific focus is given to atherosclerosis. Data on atherosclerosis in T1DM are limited, but observations suggest that atherosclerotic burden differs from in T2DM. Mechanisms that may explain the difference in atherosclerotic burden in T1DM and T2DM are discussed, including inflammation, genetics, and CVD risk factors and modifiers of disease like glycaemic control, dyslipidaemia, kidney disease, hypertension and smoking.

Outlining the available evidence reveals that a lot is still unknown about the mechanism and therefore options to reduce CVD risk in T1DM. The document sums up gaps in the evidence, and highlights the need for further study of this poorly studied area.
In addition, approaches are suggested on how to assess CVD burden in T1DM, in the absence of risk-prediction algorithms for patients with T1DM.  

de Ferranti SD, de Boer IH, Fonseca V, et al., Type 1 Diabetes Mellitus and Cardiovascular Disease: A Scientific Statement From the American Heart Association and American Diabetes Association. Circulation 2014. Published online August 11. doi: 10.1161/​CIR.0000000000000034
Find the Scientific Statement online