Harjutsalo V, Pongrac Barlovic D, Per-Hernik G, et al. - In individuals with childhood-onset type 1 diabetes, the risk of cardiovascular disease has decreased over time in Finland. Nevertheless, in comparison with the general population, there is still considerable excess cardiovascular disease risk in individuals with type 1 diabetes. These outcomes demonstrate the need for studies on the mechanisms of atherosclerosis from the time of diagnosis of type 1 diabetes to facilitate early and effective prevention of cardiovascular disease in these individuals.

• Researchers recruited a total of 11,766 individuals in this study.

• A total of 1,761 individuals had single or multiple types of cardiovascular disease events during 361,033 person-years of follow-up and a median of 29·6 years (IQR 22·3-37·9) follow-up.

• They have reported 2,686 events (864 [32·2%] coronary artery disease events, of which 663 were acute myocardial infarctions; 497 [18·5%] strokes; 854 [31·8%] peripheral artery diseases, of which 498 were lower extremity amputations; and 471 [17·5%] heart failure events) until Dec 31, 2016, and 1,467 deaths until Dec 31, 2017.

• As per the findings, cardiovascular disease risk reduced linearly by 3·8% (hazard ratio [HR] 0·96 [95% CI 0·96–0·97]; p<0·0001) by later calendar year of diabetes diagnosis (p<0·0001).

• Results showed a reduction in the SIRs for both coronary artery disease and stroke within all 10-year age groups under 65 years, except for stroke in the oldest age group.

• Nevertheless, for coronary artery disease, the SIR was still 8·9 (95% CI 3·9–17·5) and 2·9 (1·3–5·7) for stroke in those diagnosed with type 1 diabetes in the 1990s.

• Finally, there was a constant reduction in cardiovascular disease death rate by diagnosis year.