Steno Type 1 Risk Engine calculator for estimating the 10-year cardiovascular risk in type 1 diabetes

The Steno Type 1 Risk Engine is the model published in 2016 by the Steno Diabetes Center in Copenhagen for patients with type 1 diabetes [1]. It was built on data from 4306 adults followed between 2001 and 2013 and validated in a further 2119 patients from Denmark [1]. The model estimates the risk of a first cardiovascular event, fatal or non-fatal, over the next 5 and 10 years. The event includes ischemic heart disease, ischemic stroke, heart failure and peripheral artery disease [1].

The model is meant for adults with type 1 diabetes without known cardiovascular disease [1]. Calculators built for the general population or for type 2 diabetes generally do not take into account diabetes duration and glycemic control. The Steno calculator uses ten variables: age, sex, diabetes duration, systolic blood pressure, LDL cholesterol, HbA1c, albuminuria, glomerular filtration rate, smoking and regular exercise [1]. For type 2 diabetes use the SCORE2-Diabetes calculator or PREVENT, both available on this site.

The figure is the probability of a first cardiovascular event over the next 10 years, and the second figure shows the same probability at 5 years [1]. The official calculator divides the risk into three categories: low under 10%, medium from 10% to under 20%, and high from 20% upwards. The thresholds come from the NICE guideline on cardiovascular prevention, used in the United Kingdom [2].

The 2026 ADA/EASD consensus for adults with type 1 diabetes recommends a statin over the age of 40 [3]. Between 20 and 39, a statin is considered when the 10-year risk, estimated with a calculator suited to type 1, exceeds 10% [3]. For such a risk, the LDL cholesterol target in primary prevention is under 70 mg/dL (1.8 mmol/L), with a reduction of at least 50% from the starting value [3]. Your doctor sets the treatment plan, from the estimated risk and the other clinical data.

In the derivation cohort, the model ranked the risk correctly with a C-index of 0.826, and in the Danish validation of 0.803, which is very good [1]. In Scotland, in 27527 patients, it kept its discrimination but overestimated the number of events by about 27% [4]. In Italy, in 456 adults followed for 8.5 years, it separated the three risk categories well [5]. In Hong Kong, in Chinese patients with type 1 diabetes, the calibration was good [6].

Your figure is therefore an estimate for a Northern European population, not an individual prediction. Outside Denmark, the real risk may be lower compared with the one shown [4]. The 2023 ESC guideline recommends for type 1 diabetes a Scottish–Swedish model, with results close to Steno but with more variables [4] [7]. Use the result for the conversation with your doctor, not instead of it.

You need a recent set of laboratory results, with LDL cholesterol, HbA1c, creatinine and the urine albumin-to-creatinine ratio. The glomerular filtration rate is calculated from creatinine, for example with the eGFR calculator on this site. Albuminuria is chosen by the albumin-to-creatinine ratio [1]. It is normal under 30 mg/g (3 mg/mmol), moderately increased from 30 to 299 mg/g (3–30 mg/mmol) and severely increased from 300 mg/g (30 mg/mmol). Regular exercise means at least 3.5 hours of physical activity per week [1].

The calculator accepts LDL cholesterol in mg/dL or mmol/L and HbA1c in percent or mmol/mol. The model was built in adults, so under 18 the calculator stops. If you have had a heart attack, a stroke or another cardiovascular disease, the model does not apply. The result appears as soon as all the fields are filled in.