Cardiovascular disease remains the leading cause of morbidity in type 1 diabetes, yet risk stratification in younger and diverse populations remains challenging. Presented at the European Association for the Study of Diabetes 2025, this study compared two type 1 diabetes-specific cardiovascular risk models—the Steno Type 1 Risk Engine (ST1RE) and the Scottish-Swedish model—in 435 adults without prior cardiovascular disease. 

Participants were predominantly young (median age 25 years, 86% under 40) and followed for a median of 9.2 years. The Scottish-Swedish model classified 75% as low risk, 13% moderate, and 12% high risk, while ST1RE classified 84% as low, 11% moderate, and 5% high risk. Agreement between models was moderate (Cohen’s κ = 0.550). Over follow-up, 24 participants (5.5%) experienced cardiovascular events. 

Both models successfully stratified individuals with significantly higher event rates in moderate- and high-risk groups. Discriminative ability was excellent, with C-statistics of 0.916 for the Scottish-Swedish model and comparable performance for ST1RE. These results highlight the value of type 1 diabetes-specific tools to guide primary prevention and optimize early intervention strategies in young and diverse populations.