Llauradó Cabot, GemmaCano, AlbertHernández Rodríguez, CristinaGonzález-Sastre, MontserratRodríguez, Ato-AntonioPuntí, JordiBerlanga, EugenioAlbert, LaraSimó, RafaelVendrell, JoanGonzález Clemente, José Miguel2018-02-272018-02-272017Llauradó G, Cano A, Hernández C, González-Sastre M, Rodríguez AA, Puntí J. et al. Type 1 diabetes: Developing the first risk-estimation model for predicting silent myocardial ischemia. The potential role of insulin resistance. PLoS One. 2017 Apr 3;12(4):e0174640. DOI: 10.1371/journal.pone.01746401932-6203http://hdl.handle.net/10230/34008OBJECTIVES: 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. RESEARCH, DESIGN AND 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). CONCLUSION: 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.application/pdfeng© 2017 Llaurado et al. This is an open access article distributed under the terms of the https://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Diabetis -- ComplicacionsIsquèmiaMalalties coronàriesinfo:eu-repo/semantics/articlehttp://dx.doi.org/10.1371/journal.pone.0174640info:eu-repo/semantics/openAccess