title: Type 1 diabetes: Developing the first risk-estimation model for predicting silent myocardial ischemia. The potential role of insulin resistance.
abstract: OBJECTIVE
  The aim of the study was to develop a novel risk estimation model for predicting silent myocardial ischemia (SMI) in patients with type 1 diabetes (T1DM) and no clinical cardiovascular disease, evaluating the potential role of insulin resistance in such a model. Additionally, the accuracy of this model was compared with currently available models for predicting clinical coronary artery disease (CAD) in general and diabetic populations.
  
  
  METHODS
  Patients with T1DM (35-65years, >10-year duration) and no clinical cardiovascular disease were consecutively evaluated for: 1) clinical and anthropometric data (including classical cardiovascular risk factors), 2) insulin sensitivity (estimate of glucose disposal rate (eGDR)), and 3) SMI diagnosed by stress myocardial perfusion gated SPECTs.
  
  
  RESULTS
  Eighty-four T1DM patients were evaluated [50.1±9.3 years, 50% men, 36.9% active smokers, T1DM duration: 19.0(15.9-27.5) years and eGDR 7.8(5.5-9.4)mg·kg-1·min-1]. Of these, ten were diagnosed with SMI (11.9%). Multivariate logistic regression models showed that only eGDR (OR = -0.593, p = 0.005) and active smoking (OR = 7.964, p = 0.018) were independently associated with SMI. The AUC of the ROC curve of this risk estimation model for predicting SMI was 0.833 (95%CI:0.692-0.974), higher than those obtained with the use of currently available models for predicting clinical CAD (Framingham Risk Equation: 0.833 vs. 0.688, p = 0.122; UKPDS Risk Engine (0.833 vs. 0.559; p = 0.001) and EDC equation: 0.833 vs. 0.558, p = 0.027).
  
  
  CONCLUSIONS
  This study provides the first ever reported risk-estimation model for predicting SMI in T1DM. The model only includes insulin resistance and active smoking as main predictors of SMI.
authors.affiliation: Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.|Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Llauradó
authors.affiliation: Department of Endocrinology and Nutrition, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Cano
authors.affiliation: Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.|Diabetes and Metabolism Research Unit, Institut de Recerca Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Hernández
authors.affiliation: Ophthalmology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: González-Sastre
authors.affiliation: Nuclear Medicine Department, UDIAT Centre Diagnòstic, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
authors.forename: Ato-Antonio
authors.initials: AA
authors.lastname: Rodríguez
authors.affiliation: Cardiology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Puntí
authors.affiliation: Biochemistry Department, UDIAT Centre Diagnòstic, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Berlanga
authors.affiliation: Department of Endocrinology and Nutrition, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
authors.forename: Lara
authors.initials: L
authors.lastname: Albert
authors.affiliation: Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.|Diabetes and Metabolism Research Unit, Institut de Recerca Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Simó
authors.affiliation: Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.|Hospital Universitari Joan XXIII de Tarragona, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili, Tarragona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Vendrell
authors.affiliation: Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.|Department of Endocrinology and Nutrition, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
authors.forename: José-Miguel
authors.initials: JM
authors.lastname: González Clemente
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003922:Diabetes Mellitus, Type 1 / Q000473:pathology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis; D008875:Middle Aged; D008962:Models, Theoretical; D017202:Myocardial Ischemia / Q000175:diagnosis*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D059289:Vascular Stiffness / Q000502:physiology