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June 12, 2026Cardiovascular DiabetologyOpen Access

The ST1RE and Scottish-Swedish risk scores strongly discriminated imaging-defined subclinical atherosclerosis in asymptomatic adults with type 1 diabetes, with AUCs of 0.899 and 0.907, respectively.

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Why the study?

Do T1D-specific cardiovascular risk models (ST1RE and Scottish-Swedish) better predict subclinical atherosclerosis compared to 2019 ESC guidelines in asymptomatic adults with type 1 diabetes?

Population

101 asymptomatic adults with type 1 diabetes without a history of cardiovascular disease, mean age 45.3 ±…

Comparison

Type 1 Diabetes-specific cardiovascular risk… vs 2019 European Society of Cardiology Guidelines…

Design

Cross-sectional, Readers of CCTA were blinded to the patients' clinical data

Key result

The ST1RE and Scottish-Swedish risk scores strongly discriminated imaging-defined subclinical atherosclerosis in asymptomatic adults with type 1 diabetes, with AUCs of 0.899 and 0.907, respectively.

Authors

CMChiara MolinariAGArianna GalottaSMS Mushtaq

Discussion

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Member takes

Overview

Indicates high subclinical atherosclerosis burden; leaves open whether routine imaging refines risk stratification in similar patients.

Key Points

  • The study aims to evaluate cardiovascular risk models in predicting subclinical atherosclerosis in adults with type 1 diabetes.
  • Cross-sectional analysis of T1D adults without prior cardiovascular disease.
  • Participants underwent coronary computed tomography angiography (CCTA) and carotid ultrasound.
  • Performance of T1D-specific cardiovascular risk models was assessed for predicting subclinical atherosclerosis.
  • Subclinical atherosclerosis was identified in 66 of 101 participants (65.4%).
  • Strong discrimination for the composite imaging endpoint was observed with ST1RE (AUC 0.899) and Scottish-Swedish models (AUC 0.907).
  • Calibration for both models showed acceptable Brier scores of 0.126 and 0.128, respectively.

Study Design

Type

Cross-Sectional (n=101)

Multicenter

No

Structured PICO

Do T1D-specific cardiovascular risk models (ST1RE and Scottish-Swedish) better predict subclinical atherosclerosis compared to 2019 ESC guidelines in asymptomatic adults with type 1 diabetes?

P
Population
101 asymptomatic adults with type 1 diabetes and no prior cardiovascular disease underwent cross-sectional evaluation with coronary computed tomography angiography and carotid ultrasound.
E
Exposure
Type 1 Diabetes-specific cardiovascular risk models: Steno Type 1 Risk Engine (ST1RE) and Scottish-Swedish CVD risk prediction tool
C
Comparator
2019 European Society of Cardiology (ESC) Guidelines risk stratification
O
Outcome
Composite imaging endpoint defined as any coronary plaque on coronary computed tomography angiography (CCTA) and/or maximum carotid intima-media thickness (cIMTmax) ≥ 1.5 mmsurrogate

Main Result

Effect estimate: AUC 0.899 (ST1RE) and 0.907 (Scottish-Swedish)

Type 1 diabetes-specific cardiovascular risk scores (ST1RE and Scottish-Swedish) accurately identify subclinical atherosclerosis in asymptomatic adults with T1D, significantly outperforming standard 2019 ESC guidelines.

Limitations

  • Risk tools predict clinical events rather than imaging findings, requiring recalibration
  • Prospective validation against imaging endpoints is needed
  • Single-centre cross-sectional analysis
  • Tools predict clinical events rather than imaging findings, requiring recalibration and prospective validation against imaging endpoints
  • Small sample size and clinical variability limited sub-analyses (e.g., SCORE2-Diabetes analysis)

Cite This Study

Molinari et al. (2026) conducted a cross-sectional in Type 1 Diabetes (n=101). T1D-specific cardiovascular risk models (ST1RE and Scottish-Swedish risk score) was evaluated on Composite imaging endpoint (any coronary plaque on CCTA and/or maximum carotid intima-media thickness ≥1.5 mm) (AUC 0.899 (ST1RE) and 0.907 (Scottish-Swedish)). The ST1RE and Scottish-Swedish risk scores strongly discriminated imaging-defined subclinical atherosclerosis in asymptomatic adults with type 1 diabetes, with AUCs of 0.899 and 0.907, respectively.

synapsesocial.com/papers/6a2bd11d6550ea4541ffe8fchttps://doi.org/10.1186/s12933-026-03245-6
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Risk Stratification and Coronary Optical Coherence Tomography Findings in Asymptomatic Patients With Type 1 Diabetes Mellitus2025
  2. 22965-LB: Cardiovascular Disease Risk Prediction in Type 1 Diabetes over 30 Years2026
  3. 3AI-Guided Cardiac Computer Tomography in Type 1 Diabetes Patients with Low Coronary Artery Calcium Score2025
  4. 4Preclinical carotid atherosclerosis is independently associated with cardiovascular events and mortality in type 1 diabetes2026
  5. 5Factors Involved in the Progression of Preclinical Atherosclerosis in People with Type 1 Diabetes2025