Family histories of Type II diabetes and hypertension predict intima–media thickness in patients with Type I diabetes

Abstract

Aims/hypothesis. Hyperglycaemia predicts microvascular complications but data on macrovascular disease are limited. We searched for predictors of carotid artery intima-media thickness in young adults with Type I (insulin-dependent) diabetes mellitus. Methods. A total of 71 children (F/M = 34/37) were followed after their diagnosis until they reached 32 ± 1 years of age, when duration of diabetes averaged 22 ± 1 years. Cardiovascular risk markers [lipids, blood pressure, smoking, urinary albumin excretion rate, lifetime glycaemic exposure (A 1c months), exercise habits, alcohol consumption, family history] were evaluated at age 21 ± 1 for the baseline examination and at age 32 ± 1 years for the follow-up examination years. During follow-up, intima-media thickness of common and internal carotid arteries and the carotid bulb were quantitated using a high-resolution B-mode ultrasound.Results. In univariate analysis, age, BMI, blood pressure, lifetime glycaemic exposure, a positive family history of Type II (non-insulin-dependent) diabetes mellitus, hypertension and cardiovascular disease were predictors of carotid intima-media thickness. In multivariate analysis, a positive family history of Type II diabetes predicted maximal (p < 0.05) and common (p < 0.005) carotid artery intima-media thickness, family history of hypertension predicted increases in maximal (p < 0.04), and far wall (p < 0.006) carotid artery intima-media thickness, and lifetime glycaemic exposure was an independent predictor of increased carotid bulb thickness (p < 0.03). Conclusion/interpretation. Positive family histories of Type II diabetes and hypertension are independent predictors of carotid intima-media thickness in patients with Type I diabetes, and could therefore predispose these patients to atherosclerosis [Diabetologia (2002) 45:711-718]

Effect of Parental Type 2 Diabetes on Offspring With Type 1 Diabetes

“…However, a positive maternal history of type 2 diabetes was associated with a higher prevalence of cardiovascular hard end points and coronary heart disease, although the association was not significant in the age-adjusted multivariate analysis. Previous studies have indeed shown an association with intermediate markers of cardiovascular disease such as carotid intima-media thickness (17) as well as with cardiovascular disease itself (13). Regarding microvascular complications, a family history of type 2 diabetes has been associated with diabetic retinopathy (18) and with diabetic nephropathy in some (13)(14)(15)18) but not all (11) studies.…”

Type 1 and Type 2 Diabetes

“…Family history of type 2 diabetes was a significant risk factor for coronary artery disease (13), and parental type 2 diabetes conferred a threefold risk for nephropathy after adjustment for sex, glycemic control, and family history of hypertension (21). Furthermore, family history of type 2 diabetes and/or hypertension predicted progression of carotid intima-media thickness in a 10-year follow-up study of type 1 diabetic patients, who at baseline were ϳ21 years old with diabetes duration of 12 years (22). Preliminary data from the FinnDiane Study showed that according to the National Cholesterol Education Program criteria for metabolic syndrome, one-third of normoalbuminuric type 1 diabetic patients had metabolic syndrome, and 14% fulfilled more than four diagnostic criteria (23).…”

Why do some patients with type 1 diabetes live so long?

“…While a significant relationship existed between stenosis and glycaemic control (a 6.1% increase in vessel stenosis for every 1% increase in HbA1c over 18 years), glycaemic control was less significant as a risk factor than the age of the subjects and the effect of elevated serum cholesterol. In another cohort of 125 patients with a mean duration of diabetes of 22 years [12] , IMT was compared to an index of lifetime glycaemic exposure. This demonstrated significantly increased IMT only on those at the highest tertile of glycaemic exposure.…”

“…This adage was supported by the "Golden Years Cohort" [10] , where on average, both parents of those surviving 50 years with diabetes lived to over 70 years. Furthermore, a family history of either type 2 diabetes or hypertension has been shown to result in significantly increased IMT in type 1 diabetes subjects [12] . Clearly, a complex interaction exists between multiple risk factors in determining which patients with type 1 diabetes are likely to live into older age (Figure 4).…”