Cardiovascular disease is present in adolescents with diabetes

Abstract

In this issue of The Journal, Urbina et al report the results of a population-based ascertainment of the prevalence of increased arterial stiffness in children with type 1 diabetes (T1DM). This multi-center SEARCH for Diabetes in Youth Study was designed to determine the prevalence and risk factors for vascular stiffness in youth with type 1 diabetes. Vascular stiffness, using SphygmoCor tonometry to measure pulse wave velocity and augmentation index, and vascular function, using brachial artery distensibilty, were measured in 535 adolescents with T1DM and the results were compared to measurements done in 241 healthy controls. The authors found that T1DM was an independent predictor of increased arterial stiffness and decreased arterial distensibility compared with controls, even after controlling for cardiovascular risk factors. Peripheral stiffness, which correlates with LVH and is associated with peripheral artery disease and vessel calcification, was more common than central stiffness. Hypertension, high LDL-C, and low HDL-C also were associated with increased vessel stiffness. The most consistent predictors of vessel stiffness were TIDM, male sex, and increased mean arterial pressure. This work demonstrates that patients with TIDM, even at a young age, are at increased risk for vascular stiffness and abnormal endothelial function by nature of their disease. These problems are compounded when hypertension and dyslipidemia are present. We currently do a poor job of treating these co-morbidities. This study underscores the fact that these children really are at risk for vascular disease at an earlier age than controls (mean age 14.6 years) and that modifiable risk factors should be monitored and, if they are abnormal, aggressive treatment undertaken. As only surrogate markers of cardiovascular disease are present in children, the ability to monitor abnormalities to determine efficacy of therapies and to allow for studies to determine the best treatment for these children is important. Prevalence of Increased Arterial Stiffness in Children with Type 1 Diabetes Mellitus Differs by Measurement Site and Sex: The SEARCH for Diabetes in Youth StudyThe Journal of PediatricsVol. 156Issue 5PreviewTo discuss vascular stiffness commonly encountered in children with type 1 diabetes mellitus (T1DM). Full-Text PDF