Adherence to Modified American Heart Association Cardiovascular Health Standards Is Associated With Lower Atherosclerotic Burden in Mediterranean Individuals With Type 1 Diabetes

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Abstract
Objectives: Cardiovascular risk factor (CVRF) management and healthy lifestyles protect against cardiovascular disease (CVD), although their impact in type 1 diabetes (T1D) is underexplored. This study aimed to examine the relationship between healthy lifestyle parameters and preclinical atherosclerosis in this population.Materials and Methods: Cross‐sectional study in individuals with T1D without established CVD, meeting one of the following: ≥ 40 years‐old, diabetic kidney disease, or ≥ 10 years duration of T1D with another CVRF. We used a modification of the American Heart Association ‘Life's Simple Seven’ (AHA‐LSS) scoring system, measuring 7 variables (body mass index, smoking, physical activity, Mediterranean diet, LDL‐cholesterol, blood pressure, and HbA1c) scoring ranging 0–13 points (higher score, better CVRF profile). Presence of plaques was assessed using carotid ultrasound. Patients were categorised into low (AHA‐LSS ≤ 5), medium (AHA‐LSS 6–7) and high (AHA‐LSS ≥ 8) tertiles. Associations between AHA score and atherosclerosis were assessed using logistic regression models.Results: We included n = 518 individuals (55% women, age 48 ± 11 years, T1D duration 27 ± 11 years, HbA1c 7.49 ± 0.90%, AHA‐LLS 6 [5–8]). An inverse relationship was observed between AHA‐LSS score and different CVRFs and plaque burden (p < 0.05 for all). This inverse relationship persisted after adjusting for classical and specific‐T1D CVRFs not included in the score, both for plaque presence (OR 0.37 [0.20–0.70]) and ≥ 2 plaques (OR 0.30 [0.13–0.68]; p < 0.05).Conclusions: Holistic control of CVRFs and healthy lifestyles are associated with lower preclinical atherosclerosis prevalence in individuals with T1D. These findings highlight the need to address non‐glycaemic factors in this population to improve cardiovascular health.

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