Abstract
Cardiovascular disease (CVD) is the primary cause of higher and earlier morbidity and mortality in people with type 1 diabetes (T1D) compared to people without diabetes. In addition, women with T1D are at an even higher relative risk for CVD than men. However, the underlying pathophysiology is not well understood. Atherosclerotic changes are known to progress early in life among people with T1D, yet it is less clear when excess CVD risk begins in females with T1D. This review explores the prevalence of classical CVD risk factors (such as glycemic control, hypertension, dyslipidemia, obesity, albuminuria, smoking, diet, physical inactivity), as well as of novel biomarkers (such as chronic inflammation), in children and adolescents with T1D with particular regard to sex-related differences in risk profile. We also summarize gaps where further research and clearer clinical guidance are needed to better address this issue. Considering that girls with T1D might have a more adverse CVD risk profile than boys, the early identification of and sex-specific intervention in T1D would have the potential to reduce later CVD morbidity and excess mortality in females with T1D. To conclude, based on an extensive review of the existing literature, we found a clear difference between boys and girls with T1D in the presence of individual CVD risk factors as well as in overall CVD risk profiles; the girls were on the whole more impacted.
Highlights
Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in persons with type 1 diabetes (T1D) [1], and it is more frequent in this population than in individuals without diabetes [2,3]
This review explores the prevalence of classical CVD risk factors, as well as of other biomarkers, in children and adolescents with T1D with particular regard to sex-related differences in risk profile
Hypertension in children and adolescents is defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) that is ≥95th percentile for sex, age, and height on more than three occasions [131]
Summary
Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in persons with type 1 diabetes (T1D) [1], and it is more frequent in this population than in individuals without diabetes [2,3]. In a study by Brown et al, HbA1c levels, total cholesterol (Tc), low-density lipoprotein cholesterol (LDL-c), body mass index (BMI), and blood pressure (BP) were higher in females than in males, allowing the authors to conclude that, independently of other risk factors, female sex appears to modulate the impact of other mediators on CVD risk in a more atherogenic profile [20]. It is less clear when excess CVD risk begins in females with T1D. “Health-related quality of life”, “Diabetes management”, “Multiple cardiovascular risk factors”, “Recommendations”, “Screening”, and “Prevention” in the English language in the PubMed, Mendeley, and Cochrane databases
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