Early atherosclerosis in childhood type 1 diabetes: role of raised systolic blood pressure in the absence of dyslipidaemia

Abstract

The intentions of our investigation were (1) to search for atherogenic risk factors and signs of incipient atherosclerosis in children and adolescents with type 1 diabetes (T1DM) in comparison to well-matched control subjects, (2) to evaluate risk factor associations with carotid intima media thickness (cIMT) in diabetic patients and control subjects, and (3) to acquire a better knowledge of early atherogenesis in children and adolescents with and without T1DM. 94 diabetic children (age median 12.3 years, HbA1c median 7.7%) and 40 non-diabetic controls (age median 12.3 years) were investigated. Mean cIMT was determined using high-resolution B-mode ultrasound with an automated contour identification procedure. Compared to controls, subjects with diabetes had significantly elevated cIMT (p = 0.041) and systolic BP (p = 0.007) but showed a less atherogenic lipid profile. Most markers of inflammation, endothelial function and fibrinolytic activity were higher in diabetic subjects than in controls. Multiple linear regression analysis revealed a significant relationship (r = 0.53, p = 0.036) between bilateral mean cIMT and diverse risk factors in patients with T1DM. Spearman rank correlation showed that diabetes duration (rho = 0.32, p = 0.029), systolic BP (rho = 0.32, p = 0.004), weight (rho = 0.257, p = 0.022), and height (rho = 0.265, p = 0.018) significantly correlated with bilateral mean cIMT in the 94 diabetic patients. In conclusion, in well-controlled type 1 diabetic children systolic BP may be of greater importance than dyslipidaemia in early atherogenesis. BMI, markers of sustained inflammation, endothelial dysfunction and fibrinolytic activity are increased in diabetic versus non-diabetic children but none of them correlates significantly with cIMT. Their prognostic value remains to be determined.

Increased intima-media thickness of the carotid artery in childhood: a systematic review of observational studies

“…Higher values of serum lipids or blood pressure in the patient group were infrequent, systolic blood pressure values being qualified as prehypertensive in the patient group of one study [88]. Patients with HT were not included in 5/13 studies and were not obese in 13/13 studies; the median diabetes duration was 5. reported significantly higher cIMT values in the patient group with retinopathy compared with the patient group without complications, independent of z score BMI, systolic blood pressure, and diabetes duration.…”

Hypertension in type 1 diabetic patients-the influence of body composition and body mass index: an observational study

“…Higher blood pressure leads to diabetic macro-and microangiopathy. Type 1 diabetic children and adolescents have higher blood pressure values and they have hypertension or prehypertension more often in comparison with their healthy peers (20,21). The relation of pathogenesis of diabetes and hypertension is still a subject of many researches.…”

Macrovascular angiopathy in children and adolescents with type 1 diabetes

“…An increase in the mean cIMT and of systolic BP was observed despite a normal lipid profile. In a multiple linear regression analysis, a significant relationship (r = 0.53, p = 0.036) between bilateral mean cIMT and systolic BP (r = 0.32, p = 0.004) was documented [194].…”