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Preeclampsia as an independent predictor of atherosclerosis progression in women with type 1 diabetes: a 5-year prospective study

Year: 2025

Type: article

Abstract: Preeclampsia (PE) and type 1 diabetes (T1D) are significant risk factors for cardiovascular disease (CVD), but their combined effect on atherosclerosis progression has not been fully explored. This study aimed to evaluate the impact of T1D and PE on the progression of atherosclerosis. Prospective cohort study of 112 women divided into four groups: T1D + /PE + (n = 28), T1D + /PE− (n = 28), T1D−/PE + (n = 28), and T1D−/PE− (n = 28). Participants underwent an initial assessment and a follow-up visit five years later, which included anthropometric evaluation, blood tests, and carotid ultrasound. Atherosclerosis progression was defined as an increase in carotid plaque number or the occurrence of a cardiovascular event (CVE) during follow-up (fatal or non-fatal ischemic heart disease, fatal or non-fatal stroke, and/or heart failure). A total of 104 women (92.9%) completed the follow-up (54 with T1D, mean age at inclusion 45.2 ± 7.6 years, mean follow-up 5.3 ± 1.2 years). An increase in carotid plaques was identified in 34 women (32.7%), and 3 CVEs (2.9%) occurred. In women with T1D, a history of PE was associated with a twofold increase in atherosclerosis progression (57.7% vs 25.0%, p = 0.015). In multivariate models adjusted for age, T1D and cardiovascular risk factors, PE [OR 4.97 (1.61–15.29), p = 0.005] and PE + T1D [OR 7.69 (1.25–47.29), p = 0.028] were independently associated with atherosclerosis progression. PE was a strong independent predictor of atherosclerosis progression over a 5-year follow-up period, with an additive effect in T1D. These findings highlight preeclampsia as a significant CVD risk enhancer in young women with T1D. Women with type 1 diabetes (T1D) experience twice the excess risk of cardiovascular events compared to men, relative to individuals without T1D. Women with T1D have a higher prevalence of preeclampsia, an independent sex-specific cardiovascular risk factor. In a previous study, a history of preeclampsia was associated with preclinical atherosclerosis in women with T1D, but its independent relationship with atherosclerosis progression remains unexplored. Does previous preeclampsia independently predict atherosclerosis progression in women with T1D over a 5-year follow-up period? Preeclampsia is a strong independent predictor of atherosclerosis progression in women with T1D.Women with both T1D and preeclampsia have twice the rate of atherosclerosis progression compared to those with T1D alone.Preeclampsia and T1D have an additive effect on atherosclerosis progression, even after adjusting for main cardiovascular risk factors. This study suggests that a history of preeclampsia should be considered a risk-enhancing factor in cardiovascular risk assessments for women with T1D, potentially leading to more intensive prevention strategies.

Source: Cardiovascular Diabetology

DOI: 10.1186/s12933-025-02719-3