Marked smoking-associated increase of cardiovascular risk in childhood type 1 diabetes

Abstract

Type 1 diabetes is a generally accepted atherogenic risk factor, and diabetic patients who smoke markedly accelerate the atherosclerotic process. The main intentions of our investigation were to ascertain differences between juvenile active/passive smokers and non-smokers with type 1 diabetes regarding the number and spectrum of cardiovascular risk factors and their associations with smoking. Ninety-two patients were enrolled comprising 19 active/passive smokers (median age 15.9 years) and 73 non-smokers (median age 12.3 years). To determine age-dependent influences we compared age-and gender-matched groups of 12 smokers with 12 non-smokers. Smokers had significantly higher HbAlc, fructosamine, total cholesterol, LDL cholesterol, apolipoprotein B, serum P-selectin, and lower serum Lselectin than non-smokers. However, L-selectin levels were not different between the age-matched smoker and non-smoker groups. A significant positive relation (Spearman rank correlation) was found between smoking and age, HbAlc, fructosamine, total cholesterol, apolipoprotein B, and P-selectin; a negative relationship between smoking and L-selectin. We conclude that smoking in children and adolescents with type 1 diabetes increases the cardiovascular risk through the deterioration of glucose metabolism, lipid profile, and endothelial function. Therefore, smoking diabetic juveniles may increase their number of cardiovascular risk factors from 1, diabetes, by another four factors, i.e. smoking, hyperglycemia, dyslipidemia, and endothelial perturbation.

Type 1 diabetes: Developing the first risk-estimation model for predicting silent myocardial ischemia. The potential role of insulin resistance

“…It is well known that smoking is a major risk factor for CVD. In T1DM, smoking has been associated with several cardiovascular risk factors (such as physical inactivity, worse glycaemic control or more atherogenic lipid profile and endothelial dysfunction)[39,40]. The role of smoking as cardiovascular risk factor in T1DM is strongly supported by a recent risk estimation model for predicting clinical cardiovascular events (a composite of fatal and non-fatal events of CAD, ischemic stroke, heart failure and peripheral artery disease) developed in a large cohort of T1DM subjects, in which smoking was identified as one of its main predictor factors [41].…”

Type 1 Diabetes Mellitus and Cardiovascular Disease: A Scientific Statement From the American Heart Association and American Diabetes Association

“…In patients with T1DM, cigarette smoking increased the risk of DM nephropathy, retinopathy, and neuropathy (214,215), possibly because of adverse effects on inflammation and endothelial function. Smoking increases CVD risk factors in T1DM via deterioration in glucose metabolism, lipids, and endothelial function (216). Unfortunately, smoking cessation can result in weight gain, which may deter smokers with DM from quitting (217).…”

Type 1 Diabetes Mellitus and Cardiovascular Disease

“…Smoking increases CVD risk factors in T1DM via deterioration in glucose metabolism, lipids, and endothelial function. 216 Unfortunately, smoking cessation can result in weight gain, which may deter smokers with DM from quitting. 217 There is no evidence regarding the efficacy and safety of smoking cessation pharmacotherapy in patients with T1DM.…”