Arterial stiffness indices in children and adolescents with type 1 diabetes mellitus: A meta‐analysis

Christoforidis, Athanasios; Georeli, Irene; Dimitriadou, Meropi; Galli‐Τsinopoulou, Assimina; Stabouli, Stella

doi:10.1002/dmrr.3555

Cited by 7 publications

(3 citation statements)

References 49 publications

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“…We report that PWV at ≈20 years of age among participants with T1D varies by self‐identified race and ethnicity. PWV varied by 0.17 to 0.40 m/s in the base model, which is similar to the difference previously reported for youth and young adults with versus without T1D, 23 and corresponds to as much as a 9% increased risk of CVD morbidity and mortality. 24 However, these differences were attenuated by up to 27% after accounting for cardiovascular and socioeconomic‐related factors.…”

Section: Discussionsupporting

confidence: 87%

Exploring Racial and Ethnic Differences in Arterial Stiffness Among Youth and Young Adults With Type 1 Diabetes

Sauder

Glueck

Harrall

et al. 2023

JAHA

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Background We examined arterial stiffness in individuals with type 1 diabetes, and explored whether differences between Hispanic, non‐Hispanic Black (NHB), and non‐Hispanic White (NHW) individuals were attributable to modifiable clinical and social factors. Methods and Results Participants (n=1162; 22% Hispanic, 18% NHB, and 60% NHW) completed 2 to 3 research visits from ≈10 months to ≈11 years post type 1 diabetes diagnosis (mean ages of ≈9 to ≈20 years, respectively) providing data on socioeconomic factors, type 1 diabetes characteristics, cardiovascular risk factors, health behaviors, quality of clinical care, and perception of clinical care. Arterial stiffness (carotid–femoral pulse wave velocity [PWV], m/s) was measured at ≈20 years of age. We analyzed differences in PWV by race and ethnicity, then explored the individual and combined impact of the clinical and social factors on these differences. PWV did not differ between Hispanic (adjusted mean 6.18 [SE 0.12]) and NHW (6.04 [0.11]) participants after adjustment for cardiovascular risks ( P =0.06) and socioeconomic factors ( P =0.12), or between Hispanic and NHB participants (6.36 [0.12]) after adjustment for all factors ( P =0.08). PWV was higher in NHB versus NHW participants in all models (all P <0.001). Adjustment for modifiable factors reduced the difference in PWV by 15% for Hispanic versus NHW participants; by 25% for Hispanic versus NHB; and by 21% for NHB versus NHW. Conclusions Cardiovascular and socioeconomic factors explain one‐quarter of the racial and ethnic differences in PWV of young people with type 1 diabetes, but NHB individuals still experienced greater PWV. Exploration of pervasive inequities potentially driving these persistent differences is needed.

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Section: Discussionsupporting

confidence: 87%

Exploring Racial and Ethnic Differences in Arterial Stiffness Among Youth and Young Adults With Type 1 Diabetes

Sauder

Glueck

Harrall

et al. 2023

JAHA

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“…Pts. with DM show stiff conductance arteries at an early age ( Christoforidis et al, 2022 ), and is seen in pts. with metabolic syndrome before presenting with T2DM ( Donley et al, 2014 ).…”

Section: Conduit Artery Remodelingmentioning

confidence: 99%

The cardiovascular changes underlying a low cardiac output with exercise in patients with type 2 diabetes mellitus

Lav Madsen,

Sejersen,

Nyberg

et al. 2024

Front. Physiol.

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The significant morbidity and premature mortality of type 2 diabetes mellitus (T2DM) is largely associated with its cardiovascular consequences. Focus has long been on the arterial atheromatosis of DM giving rise to early stroke and myocardial infarctions, whereas less attention has been given to its non-ischemic cardiovascular consequences. Irrespective of ischemic changes, T2DM is associated with heart failure (HF) most commonly with preserved ejection fraction (HFpEF). Largely due to increasing population ages, hypertension, obesity and T2DM, HFpEF is becoming the most prevalent form of heart failure. Unfortunately, randomized controlled trials of HFpEF have largely been futile, and it now seems logical to address the important different phenotypes of HFpEF to understand their underlying pathophysiology. In the early phases, HFpEF is associated with a significantly impaired ability to increase cardiac output with exercise. The lowered cardiac output with exercise results from both cardiac and peripheral causes. T2DM is associated with left ventricular (LV) diastolic dysfunction based on LV hypertrophy with myocardial disperse fibrosis and significantly impaired ability for myocardial blood flow increments with exercise. T2DM is also associated with impaired ability for skeletal muscle vasodilation during exercise, and as is the case in the myocardium, such changes may be related to vascular rarefaction. The present review discusses the underlying phenotypical changes of the heart and peripheral vascular system and their importance for an adequate increase in cardiac output. Since many of the described cardiovascular changes with T2DM must be considered difficult to change if fully developed, it is suggested that patients with T2DM are early evaluated with respect to their cardiovascular compromise.

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“…A condition of aortic stiffness has been described even in metabolic diseases such as diabetes [34], fatty liver disease [35][36][37], kidney failure [12,38,39], and alterations in calcium metabolism [40,41]. Some metabolic disorders can be accompanied by an increase in oxidative stress, arterial medial calcifications, and by inflammation of the arterial wall [42].…”

Section: Aortic Pulse Wave Velocitymentioning

confidence: 99%

Wall Properties of Elastic and Muscular Arteries in Children and Adolescents at Increased Cardiovascular Risk

Genovesi,

Tassistro,

Lieti

et al. 2023

JCM

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Background: Pulse wave velocity (PWV) assessment represents a simple method to estimate arterial distensibility. At present, carotid-femoral PWV (cf-PWV) is considered the gold standard method in the non-invasive evaluation of the elastic properties of the aorta. On the other hand, the mechanical properties of muscular arteries can be evaluated on the axillo-brachial-radia axis by estimating the carotid-radial PWV (cr-PWV). While a number of studies have addressed these issues in adults, limited information is available on the respective features of cf-PWV and cr-PWV and on their modulating factors in children and adolescents at increased cardiovascular risk. Methods: The mechanical properties of the predominantly elastic (aorta) and muscular (axillo−brachial−radial axis) arteries were evaluated in a pediatric population characterized by either elevated blood pressure (BP) or excess body weight, and the main factors affecting cf-PWV and cr-PWV values in these individuals were investigated. Results: 443 children and adolescents (median age 11.5 years, 43.3% females) were enrolled; 25% had BP values >90th percentile and 81% were excess weight. The cf-PWV values were significantly lower than the cr-PWV values: median (Q1–Q3) = 4.8 m/s (4.3–5.5) and 5.8 m/s (5.0–6.5), respectively (p < 0.001). The pubertal development (p < 0.03), systolic BP and diastolic BP z-scores (p = 0.002), heart rate (p < 0.001), and waist-to-height ratio (p < 0.005) were significantly associated with cf-PWV values. No significant association was found between BMI z-score and cf-PWV. Predictors of high cf-PWV (>95th percentile) were the heart rate (OR 1.07, 95%CI 1.04–1.10, p < 0.001) and waist-to-height ratio (OR 1.06, 95%CI 1.0–1.13, p = 0.04). The variables significantly related with cr-PWV values were diastolic BP z-score (p = 0.001), heart rate (p < 0.01), and HOMA index (p < 0.02). No significant association was found between the cr-PWV and BMI z-score or waist-to-height ratio. Conclusions: Systolic and diastolic BP values and central obesity are associated with aortic stiffness in a population of children and adolescents at increased cardiovascular risk. In contrast, diastolic BP, heart rate, and levels of insulin resistance appear to be related to distensibility of the upper limb vascular district.

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Arterial stiffness indices in children and adolescents with type 1 diabetes mellitus: A meta‐analysis

Cited by 7 publications

References 49 publications

Exploring Racial and Ethnic Differences in Arterial Stiffness Among Youth and Young Adults With Type 1 Diabetes

Exploring Racial and Ethnic Differences in Arterial Stiffness Among Youth and Young Adults With Type 1 Diabetes

The cardiovascular changes underlying a low cardiac output with exercise in patients with type 2 diabetes mellitus

Wall Properties of Elastic and Muscular Arteries in Children and Adolescents at Increased Cardiovascular Risk

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