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Peer-reviewedCC BY-NC-NDCardiovascular diabetology

Preclinical carotid atherosclerosis is independently associated with cardiovascular events and mortality in type 1 diabetes.

  • Clara Viñals1,2
  • Ignacio Conget3,4,5
  • Camila Milad3
  • Montse Granados3
  • Jesús Blanco3,4
  • Maria Claro3,6
  • Verónica Perea7
  • Tonet Serés-Noriega8
  • Irene Vinagre3,4
  • Marga Giménez3,4,5
  • Antonio J Amor9,10,11,12
12 affiliations
  1. 1Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain. [email protected].
  2. 2Fundació Clínic per la recerca biomèdica, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. [email protected].
  3. 3Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain.
  4. 4Fundació Clínic per la recerca biomèdica, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
  5. 5Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
  6. 6Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.
  7. 7Endocrinology and Nutrition Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain.
  8. 8Endocrinology and Nutrition, Centro Médico Milenium, Gran Vía Santiago Ramón y Cajal 9, 50005, Zaragoza, Spain.
  9. 9Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain. [email protected].
  10. 10Fundació Clínic per la recerca biomèdica, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. [email protected].
  11. 11Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. [email protected].
  12. 12Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain. [email protected].
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Abstract

Background

To evaluate whether carotid atherosclerosis predicts future cardiovascular events (CVE) and mortality in adults with type 1 diabetes (T1D) in primary prevention.Methods

Cohort study in adults with T1D participating in a cardiovascular risk assessment program that included carotid ultrasound. Eligibility criteria included age ≥ 40 years, diabetic kidney disease regardless of age or diabetes duration, or type 1 diabetes duration ≥ 10 years in the presence of at least one additional cardiovascular risk factor.The primary endpoint was the first CVE. A secondary endpoint was a composite of CVE plus all-cause mortality. Carotid plaque burden and outcomes were analyzed using Kaplan-Meier curves and Cox regression models.Results

701 individuals were followed for a mean of 5.85 years (mean age 48.5 years; T1D duration 27 years; 51.9% males). Carotid plaques were identified in 40.4%. During follow-up, 45 CVE occurred (18 coronary artery disease, 14 peripheral artery disease, 6 stroke, 3 heart failure, 4 deaths) along with 5 non-cardiovascular deaths. Event-free survival declined progressively with increasing plaque burden (log-rank p < 0.001). In unadjusted analyses, the presence of any plaque was associated with increased risk of CVE (HR 3.14, 95%C I 1.69-5.84) and of the composite endpoint (HR 3.07, 95% CI 1.71-5.51). After multivariable adjustment for demographic, metabolic, and microvascular factors, a high plaque burden (≥ 3 plaques) remained associated with CVE (HR 3.38, 95% CI 1.37-8.38) and with the composite endpoint (HR 2.64, 95% CI 1.13-6.21).Conclusions

Preclinical carotid atherosclerosis in adults with T1D was independently associated with an increased risk of cardiovascular events and mortality. These findings support the potential role of carotid ultrasound as a complementary tool for cardiovascular risk assessment in individuals with T1D.

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Cite

BibTeXRIS
BibTeX
@article{vinals2026preclinical,
  title = {{Preclinical carotid atherosclerosis is independently associated with cardiovascular events and mortality in type 1 diabetes.}},
  author = {Clara Viñals and Ignacio Conget and Camila Milad and Montse Granados and Jesús Blanco and Maria Claro and Verónica Perea and Tonet Serés-Noriega and Irene Vinagre and Marga Giménez and Antonio J Amor},
  journal = {Cardiovascular diabetology},
  year = {2026},
  month = jul,
  doi = {10.1186/s12933-026-03300-2},
  url = {https://europepmc.org/article/MED/42897549},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Preclinical carotid atherosclerosis is independently associated with cardiovascular events and mortality in type 1 diabetes.
AU  - Clara Viñals
AU  - Ignacio Conget
AU  - Camila Milad
AU  - Montse Granados
AU  - Jesús Blanco
AU  - Maria Claro
AU  - Verónica Perea
AU  - Tonet Serés-Noriega
AU  - Irene Vinagre
AU  - Marga Giménez
AU  - Antonio J Amor
PY  - 2026
DA  - 2026/07/01
JO  - Cardiovascular diabetology
DO  - 10.1186/s12933-026-03300-2
UR  - https://europepmc.org/article/MED/42897549
AB  - Background  To evaluate whether carotid atherosclerosis predicts future cardiovascular events (CVE) and mortality in adults with type 1 diabetes (T1D) in primary prevention.Methods  Cohort study in adults with T1D participating in a cardiovascular risk assessment program that included carotid ultrasound. Eligibility criteria included age ≥ 40 years, diabetic kidney disease regardless of age or diabetes duration, or type 1 diabetes duration ≥ 10 years in the presence of at least one additional cardiovascular risk factor.The primary endpoint was the first CVE. A secondary endpoint was a composite of CVE plus all-cause mortality. Carotid plaque burden and outcomes were analyzed using Kaplan-Meier curves and Cox regression models.Results  701 individuals were followed for a mean of 5.85 years (mean age 48.5 years; T1D duration 27 years; 51.9% males). Carotid plaques were identified in 40.4%. During follow-up, 45 CVE occurred (18 coronary artery disease, 14 peripheral artery disease, 6 stroke, 3 heart failure, 4 deaths) along with 5 non-cardiovascular deaths. Event-free survival declined progressively with increasing plaque burden (log-rank p < 0.001). In unadjusted analyses, the presence of any plaque was associated with increased risk of CVE (HR 3.14, 95%C I 1.69-5.84) and of the composite endpoint (HR 3.07, 95% CI 1.71-5.51). After multivariable adjustment for demographic, metabolic, and microvascular factors, a high plaque burden (≥ 3 plaques) remained associated with CVE (HR 3.38, 95% CI 1.37-8.38) and with the composite endpoint (HR 2.64, 95% CI 1.13-6.21).Conclusions  Preclinical carotid atherosclerosis in adults with T1D was independently associated with an increased risk of cardiovascular events and mortality. These findings support the potential role of carotid ultrasound as a complementary tool for cardiovascular risk assessment in individuals with T1D.
SN  - 1475-2840
ER  -