Abstract
Objective of the study: This study aimed to test the effect of multiple cardiovascular risk factors on subclinical indices of atherosclerosis in children and adolescents with type 1 diabetes (T1D).Methods: Carotid intima-media thickness (cIMT), carotid distensibility coefficient (cDC), and carotid–femoral pulse wave velocity (PWV) were measured in children and adolescents with T1D, in a follow-up at the outpatient clinics of Verona. Blood pressure (BP; both central and peripheral), metabolic and other cardiovascular risk factors were evaluated in multivariate linear regressions to assess the association with the measured indices of subclinical vascular damage.Results: One hundred and twenty-six children and adolescents were included. cIMT was above the 95th percentile for age and height in 60.8% of the population, whereas 26% of the sample had cDC impairment (less than the 5th percentile) and 4.8% had an elevated PWV. Independent determinants of cIMT according to the regression models were only gender type of glucose monitoring and central systolic BP (cSBP). PWV was associated with age, sex, heart rate, and cSBP; cDC with age and both cSBP and, alternatively, peripheral BP (pBP). Neither pBP nor any of the tested metabolic parameters, including glycated hemoglobin, was associated with PWV and cIMT.Conclusions: A high proportion of early vascular damage, especially an increased cIMT, is present in children and adolescents with T1D in whom cSBP seems to be a common determinant. In children and adolescents with T1DM, a special focus should be on hemodynamic risk factors beyond metabolic ones.
Highlights
Ischemic heart disease and stroke due to atherosclerosis are responsible for a combined 15.2 million deaths according to the most recent WHO data, and they are the leading cause of death worldwide [1]
In the SEARCH cardiovascular disease (CVD) study, which evaluated 402 young patients with type 1 diabetes (T1D) in comparison with 206 matched controls, peripheral systolic blood pressure (pSBP), sex, age, and adiposity were independently associated with carotid intima-media thickness (cIMT), and the correlation was probably driven by the poor glycemic control [14]
pulse wave velocity (PWV) is a powerful tool for measuring the stiffness of large arteries and enables the identification of high-risk populations that might benefit from more aggressive cardiovascular disease (CVD) risk factor management [18]
Summary
Ischemic heart disease and stroke due to atherosclerosis are responsible for a combined 15.2 million deaths according to the most recent WHO data, and they are the leading cause of death worldwide [1]. Even if clinical manifestations occur in adulthood, atherosclerosis is a continuum process that begins early in childhood [2, 3], especially if major risk factors such as diabetes and hypertension are present. Other studies found that cIMT is not always augmented in diabetic children [16], and other markers of early atherosclerosis, such as pulse wave velocity (PWV) or carotid distensibility (cDC) could be useful if detected even earlier in childhood [17]. CDC may predict future total cardiovascular (CV) events, CV mortality, and all-cause mortality, at least in adults; measuring cDC may facilitate the identification of high-risk patients for the early diagnosis and prompt treatment of CVD [19]. The present study aimed to assess the prevalence of impaired vascular indices in children and adolescents with T1D and to analyze the effect of multiple cardiovascular risk factors on diverse subclinical indices of atherosclerosis
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