title: Vascular or chronological age: which is the better marker to estimate the cardiovascular risk in patients with type 1 diabetes?
abstract: OBJECTIVE
  To evaluate whether using vascular age (VA) instead of chronological age (CA) in the Framingham score would enhance the cardiovascular disease (CVD) risk estimation in patients with type 1 diabetes (T1D).
  
  
  METHODS
  This was a cross-sectional study comprising 58 T1D patients and 38 control subjects matched by age, gender and body mass index. To estimate the VA, we used carotid intima-media thickness normality estimation tables that took into account age, gender and ethnic group.
  
  
  RESULTS
  Compared to the control group, T1D patients had an older VA with an 8.8-year difference (p < 0.001), a higher CVD risk stratification comparing CA and VA (p < 0.001). In the group of T1D patients, there was a 9.4-year difference between VA and CA (p < 0.001), mainly due to a greater increase in women compared to men (11.2 vs 6.4 years, respectively) and 29.3 % of the patients with T1D increased their CVD risk stratification using VA as a parameter. Still, in the group of T1D patients, women had a higher increase in VA for each 1-year increase in CA than men (1.2 years vs 0.8 years, respectively, p < 0.001). This difference persisted as we compared women with T1D with women in the control group (0.4 years), p = 0.006.
  
  
  CONCLUSIONS
  T1D patients have an increased VA, a marker of subclinical atherosclerosis. The use of VA age may contribute to the identification of high CVD risk in T1D. In patients with T1D, a younger chronological age, particularly in women, might not be a protective factor for CVD.
authors.affiliation: Endocrinology Department, University Hospital of Fluminense Federal University, Rio de Janeiro, Brazil. carlosjr.andrade@gmail.com.|Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Avenida 28 de Setembro, 77, 3° andar, Rio de Janeiro, RJ, CEP 20.551-030, Brazil. carlosjr.andrade@gmail.com.|, Avenida Prof. Florestan Fernandes 1036 Bl.16 ap.503, Camboinhas, Niterói, Rio de Janeiro, CEP 24358-580, Brazil. carlosjr.andrade@gmail.com.
authors.forename: Carlos Roberto Moraes
authors.initials: CRM
authors.lastname: de Andrade
authors.affiliation: Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Avenida 28 de Setembro, 77, 3° andar, Rio de Janeiro, RJ, CEP 20.551-030, Brazil.
authors.forename: Eliete Leão Clemente
authors.initials: ELC
authors.lastname: Silva
authors.affiliation: Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Avenida 28 de Setembro, 77, 3° andar, Rio de Janeiro, RJ, CEP 20.551-030, Brazil.
authors.forename: Maria de Fátima Bevilaqua
authors.initials: MFB
authors.lastname: da Matta
authors.affiliation: Department of Internal Medicine, Cardiology Unit, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Marcia Bueno
authors.initials: MB
authors.lastname: Castier
authors.affiliation: Epidemiology and Biomaths, University Hospital of Fluminense Federal University, Rio de Janeiro, Brazil.
authors.forename: Maria Luiza Garcia
authors.initials: MLG
authors.lastname: Rosa
authors.affiliation: Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Avenida 28 de Setembro, 77, 3° andar, Rio de Janeiro, RJ, CEP 20.551-030, Brazil.
authors.forename: Marília Brito
authors.initials: MB
authors.lastname: Gomes
mesh_terms: D000328:Adult; D000375:Aging / Q000473:pathology*; D015415:Biomarkers / Q000032:analysis; D001938:Brazil / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D059168:Carotid Intima-Media Thickness / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D015415:Biomarkers
keywords: Carotid artery; Intima-media thickness; Type 1 diabetes; Vascular age