Assessment of cardiovascular risk in type 1 diabetes mellitus taking into account various markers of kidney damage
DOI: https://dx.doi.org/10.18565/nephrology.2020.4.51-55
A.E. Goldschmid, R.A. Karamullina, E.I. Chechikova, M.V. Amosova, I.V. Poluboyarinova, V.V. Fadeev
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
Objective. Assessment of the relationship of markers of diabetic nephropathy (DN) with scales specific for type 1 diabetes mellitus (DM1) and predicting the risk of cardiovascular diseases (CVD).
Methods. Screening of 176 DM1 patients was carried out: mean age – 32 years [25.5–42.5]; DM1 duration – 15 years [9–20]; HbA1c – 8.2% [7.2-9.6]. Microalbuminuria was not detected in 68.2% of the examined patients, 27% of patients had microalbuminuria, 4.5% had macroalbuminuria; the median albuminuria was 25.5 mg/day [15.0–36.5]. Mean eGFR (CKD-EPI) was 80.55±18.13 ml/min/1.73 m2: C1 – 30.1%, C2 – 58.5%, C3a – 8.5% and C3b – 2.9 %. The Steno T1 Risk Engine score assessing the 5-year CVD risk was 3.7% [2.1–8.0], the 10-year risk was 7.1% [4.2–8.15]. The Swedish T1D risk score, which estimates the 5-year CVD risk, was 0.93% [0.50–1.79]. The mean CVD risk in the group was assessed as low according to both scales.
Results. There was a significant moderate direct correlation of the albuminuria stage and an inverse correlation of eGFR with 5-year risk (r=0.388 and r=-0.506; P<0.0001), 10-year risk (r=0.393 and r=-0.500); P<0.0001) according to the Steno scale and the Swedish T1D risk score (r=0.189; P=0.012 and r=-0.497; P<0.0001). There was a strong positive correlation between the Steno risk score and the Swedish risk score (r=0.893; P<0.0001).
Conclusion. The Steno and Swedish T1D risk scales correlate with the DN stage and are equivalent to each other for assessing cardiovascular risk in DM1 patients. Swedish T1D risk score does not require quantification of albumin loss and is more convenient in clinical practice. Thus, CVD risk assessment in DM1 patients can be adequately carried out in routine clinical practice without determining microalbuminuria.
Keywords: cardiovascular diseases, diabetic nephropathy, cardiovascular risk assessment, type 1 diabetes mellitus
About the Autors
A.E. Goldschmid – Endocrinologist, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; e-mail: goldsmid93@gmail.com
R.A. Karamullina – Postgraduate student at the Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
E.I. Chechikova – Medical Resident at the Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
M.V. Amosova – Cand. Sci. (Med.), Teaching Assistant at the Department of Endocrinology №1, Institute of Clinical Medicine n.a. N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
I.V. Poluboyarinova – Cand. Sci. (Med.), Teaching Assistant at the Department of Endocrinology №1, Institute of Clinical Medicine n.a. N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
V.V. Fadeev – Corresponding member of RAS, Dr. Sci. (Med.), Professor, Director of the Clinic, Head of the Department of Endocrinology № 1, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University, Moscow