Early detection and prevention of cardiovascular disease

Abstract

The global incidence of type 1 diabetes (T1D) continues to rise worldwide, particularly among children under 5 years of age. This results in a longer lifetime exposure to the disease and, consequently, an increased risk of premature cardiovascular morbidity and mortality.

Cardiovascular disease (CVD) is the leading cause of mortality in individuals with T1D. Although clinical manifestations of CVD are uncommon before adulthood, their occurrence represents the final outcome of decades of subclinical pathological processes, largely driven by lifestyle behaviors and potentially modifiable cardiovascular risk factors. Adolescence is a particularly critical period for the development of early subclinical manifestations of cardiovascular disease. Age at disease onset is an important non-modifiable risk factor, with the greatest loss in life expectancy observed in individuals diagnosed before the age of 10 years. Sex is also a significant determinant, with a greater impact observed in females.

Although suboptimal glycemic control plays a central role in the increased cardiovascular risk associated with T1D, early and sustained exposure to traditional cardiovascular risk factors—including overweight and obesity, hypertension, dyslipidemia, microalbuminuria, physical inactivity, poor diet quality, and tobacco use, among others—accelerates the atherosclerotic process and contributes substantially to future cardiovascular risk.

Furthermore, screening for cardiovascular risk factors remains suboptimal, and pharmacological interventions are often delayed and underutilized. Therefore, there is a clear need to improve cardiovascular risk screening strategies in children and adolescents with T1D and to implement intensive risk factor management. Emerging evidence suggests that elevated urinary albumin excretion rates, even within the normal range, may identify adolescents with T1D who are at particularly high risk for future complications. Early pharmacological intervention in this high-risk group may reduce long-term cardiovascular risk.

These findings underscore the importance of recognizing cardiovascular disease in T1D as a progressive process that begins in childhood. Reducing cardiovascular morbidity and mortality requires intensified efforts toward early detection, comprehensive risk assessment, and timely intervention.