Recent publications on Residual Risk

Findings from the Swedish National Diabetes Register show the importance of lipid-lowering therapy (LLT) in the primary prevention setting for individuals with type 1 diabetes, reducing the risk of cardiovascular disease by 22–44%.
 
People with type 1 diabetes are at increased risk of cardiovascular events compared with the general population, despite recent advances in care. Recent guidelines have recommended statin therapy for type 1 diabetes individuals aged more than 40 years. However, the data for this recommendation, (based on older individuals, half of whom had cardiovascular disease), do not take account of subsequent changes in diabetes management, and thus may not be generalizable to the primary prevention setting.
 
Investigators used propensity scores for treatment with LLT, which were based on 32 baseline clinical and socioeconomic variables, to estimate the effect of LLT in the overall cohort (n=24,230 with type 1 diabetes). Over the mean follow-up of 6 years, 18,843 individuals received no treatment and 5,387 were treated with LLT (97% statins). Compared with untreated individuals, those receiving LLT had a 40% reduction in cardiovascular mortality (hazard ratio [HR] 0.60, 95% CI 0.50–0.72), 44% reduction in stroke (HR 0.56, 95% CI 0.46–0.70), and 22% reduction in myocardial infarction (HR 0.78, 95% CI 0.66–0.92). This study, the first large observational study to explore the effect of LLT in people with type 1 diabetes without previous CVD, highlights the importance of primary prevention with LLT to reduce cardiovascular risk.