Assessment of Cardiovascular Risk in Long-Term Type 1 Diabetes: The Role of Adiponectin and Leptin

Background: Individuals with long-standing type 1 diabetes (T1D) remain at elevated cardiovascular risk (CVR). Adiponectin (ADNC) and leptin (LEP) are adipokines involved in metabolic and vascular homeostasis, yet their relevance for CVR stratification in T1D is unclear. This study examined the associations of ADNC and LEP with CVR categories derived from the Steno Type 1 Risk Engine (ST1RE) and the 2019 ESC Guidelines on Diabetes, Pre-diabetes and Cardiovascular Diseases (ESC 2019), with particular attention to potential sex-related differences. Methods: A cross-sectional study included 124 adults with long-standing T1D and 59 age- and sex-matched non-diabetic participants. Serum ADNC and LEP concentrations were measured using standardized immunoassays. CVR was assessed using ST1RE and ESC 2019 algorithms. Multivariable models adjusted for age and body mass index (BMI) were used to examine determinants of adipokine concentrations and their associations with CVR categories. Results: Participants with T1D exhibited higher circulating ADNC concentrations than non-diabetic individuals (p < 0.001). LEP levels were significantly associated with sex (p < 0.001). In adjusted analyses, sex and BMI remained significantly associated with adipokine concentrations. Higher LEP levels showed a significant positive association with higher ESC 2019 CVR category (OR 1.84; 95% CI 1.19–2.84; p = 0.006), whereas ADNC and the LEP×sex interaction showed no significant association. Neither adipokine was significantly associated with ST1RE-derived risk categories. Conclusion: In adults with long-standing T1D, LEP showed an association with ESC 2019-based CVR stratification, whereas neither LEP nor ADNC was associated with ST1RE-derived risk categories.