Abstract
Aims/hypothesisVascular inflammation and endothelial dysfunction are thought to contribute to arterial stiffening and hypertension. This study aims to test this hypothesis with longitudinal data in the context of type 1 diabetes.MethodsWe investigated, in an inception cohort of 277 individuals with type 1 diabetes, the course, tracking and temporal inter-relationships of BP, specifically pulse pressure (a marker of arterial stiffening) and hypertension, and the following biomarkers of systemic and vascular inflammation/endothelial dysfunction: C-reactive protein (CRP), soluble intracellular adhesion molecule-1 (sICAM-1), soluble vascular cellular adhesion molecule-1 (sVCAM-1) and soluble E-selectin (sE-selectin). These biomarkers and other risk factors were measured at baseline and repeatedly up to 20 years after the onset of type 1 diabetes. Data were analysed with generalised estimating equations including adjustments for age, sex, smoking status, BMI, HbA1c, serum creatinine, total cholesterol, urinary AER, insulin treatment dose and mean arterial pressure.ResultsIncreases were noted in all biomarkers except sE-selectin, which decreased over time. Levels differed from baseline at 2–4 years and preceded the increase in pulse pressure, which occurred at 8–10 years after the onset of type 1 diabetes. Higher levels of sICAM-1 and sVCAM-1, but not CRP or sE-selectin, at baseline and throughout the 20 year follow-up, were significantly associated with higher (changes in) pulse pressure at subsequent time points. Higher levels of sVCAM-1 at baseline and during follow-up were also significantly associated with the prevalence (OR 3.60 [95% CI 1.36, 9.53] and OR 2.28 [1.03, 5.25], respectively) and incidence (OR 2.89 [1.08, 7.75] and OR 3.06 [1.01, 9.26], respectively) of hypertension. We also investigated the longitudinal associations between BP or hypertension as determinants of subsequent (changes in) levels of CRP, sICAM-1, sVCAM-1 and sE-selectin, but did not find evidence to support a reverse causality hypothesis.Conclusions/interpretationThese findings support the involvement of vascular endothelial dysfunction and inflammation in the development of premature arterial stiffening and hypertension in type 1 diabetes.
Highlights
Individuals with type 1 diabetes are characterised by accelerated arterial ageing [1, 2], a mechanism that increases the risk for cardiovascular disease (CVD) [2,3,4]
We investigated the longitudinal associations between BP or hypertension as determinants of subsequent levels of C-reactive protein (CRP), soluble intracellular adhesion molecule-1 (sICAM-1), soluble vascular cellular adhesion molecule-1 (sVCAM-1) and sE-selectin, but did not find evidence to support a reverse causality hypothesis
We examined the longitudinal course of BP and biomarkers of endothelial dysfunction and inflammation, and their inter-relationships, in a cohort of individuals with type 1 diabetes who had been followed for 20 years since the onset of disease
Summary
Individuals with type 1 diabetes are characterised by accelerated arterial ageing [1, 2], a mechanism that increases the risk for cardiovascular disease (CVD) [2,3,4]. This has been illustrated by a steeper positive association between age and pulse pressure, a marker of arterial stiffness [5, 6], in individuals with type 1 diabetes than in their peers without the disease [1]. In recent years, inflammation and endothelial dysfunction, as expressed by levels of C-reactive protein (CRP) and cellular adhesion molecules (CAMs), have been proposed as putative determinants of arterial stiffness/pulse pressure and
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