EASD 2020 Highlights

Conference summaries


Incident cardiovascular disease by clustering of favourable risk factors in type 1 diabetes – The EURODIAB Prospective Complications study

Presented by:

Soraya Soulimane, MD

  • In T1D, clustering of favourable CVD risk factors was associated with a lower risk of incident CVD.
  • Despite this, HbA1c remained the most protective factor against CVD in T1D.
  • However, using clusters of combined risk factors as targets for intervention has the potential to be more effective in lowering cardiovascular risk than targeting anindividual risk factor by itself.

What do we already know about this topic?

  • The incidence of cardiovascular disease (CVD) is up to eight times higher in people with type 1 diabetes (T1D) than the general population.1
  • Greater clustering of adverse risk factors is thought to contribute to excess CVD risks in type 2 diabetes, although this has not been explored in T1D.

How was this study conducted?

  • This study examined: i) CVD risk reduction for those in the most favourable third of individual risk factors compared to the least favourable two thirds; ii) CVD risk reduction by clustering of favourable CVD risk factors.
  • 2086 participants from the EURODIAB Prospective Complications study, a European T1D cohort, recruited in 16 countries, between 1989-91 were studied; 51% were men, with a mean age of 32±10 years.
  • Seven CVD risk factors were investigated, namely HbA1c, smoking, BMI, combined systolic and diastolic blood pressure (BP), LDL cholesterol, physical activity (PA) and diet.
  • Cox Proportional Hazards analyses were used to calculate hazard ratios (HR [95% CI]) of incident CVD, for each CVD risk factor (adjusted for age, sex, retinopathy), comparing those in the most favourable tertiles with the least favourable two tertiles.
  • Each individual was then scored by the number of risk factors for which they occupied the most favourable tertiles.

What does this study add?

  • There were 147 incident CVD cases, after a mean follow-up of 7.2±1.3 years.
  • Multivariable Cox models showed that participants with the most favourable HbA1c<5.7% [39 mmol/mol] had a 54% significantly lower CVD risk (HR [95%CI]: 0.46 [0.28,0.77]) than the least favourable two tertiles.
  • Non-significant inverse associations were found with favourable BMI: 0.92 [0.60,1.43], PA: 0.77 [0.52,1.16], diet score: 0.68 [0.34,1.36] and BP: 0.80 [0.46,1.39].
  • No associations were found with smoking or LDL-cholesterol.
  • Greater clustering of favourable CVD risk factors was associated with a lower risk of CVD in univariate models, with a significant linear trend.
  • In multivariate models, the results were partly attenuated, with the lowest HR of 0.52 [0.29, 0.94] in people with clustering of 3 favourable CVD risk factors.


How does this study impact clinical practice?

  • Greater clustering of favourable CVD risk factors was associated with a lower risk of incident CVD in people with T1D, with a dose-response relationship.
  • HbA1c remained the most protective factor against CVD in T1D.
  • Targeting combined risk factors could be more effective in preventing CVD risk than targeting single risk factors.



  1. Schofield J, Ho J, Soran H. Cardiovascular Risk InType 1 Diabetes Mellitus. Diabetes Ther. 2019 Jun;10(3):773-89.


Related content


This is a highlights summary of an oral session given at the EASD 2020 Virtual Meeting and presented by:

Soraya Soulimane, MD
Dept. of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases
Tilburg University, The Netherlands

The presenting authors of the original session had no part in the creation of this conference highlights summary. 

The content is produced by Infomedica. The summary text was drafted by Patrick Moore, PhD, and reviewed by Marco Gallo, MD, an independent external expert, and approved by Florian Toti, MD, the scientific editor of the program.


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