Modifiable Risk Factors for Cardiovascular Disease in Children with Type 1 Diabetes: Can Early Intervention Prevent Future Cardiovascular Events?

Abstract

Purpose of ReviewPatients with type 1 diabetes have increased risk for cardiovascular disease.The purpose of this review is to examine the following:current evidence for subclinical cardiovascular disease (CVD) in children with type 1 diabetes (T1DM)known modifiable risk factors for CVD and their relationship to subclinical CVD in this populationstudies that have addressed these risk factors in order to improve CVD outcomes in children with T1DM Recent FindingsSubclinical CVD presents in children as increased carotid intima-media thickness, increased arterial stiffness, and endothelial and myocardial dysfunction. Modifiable risk factors for CVD include hyperglycemia, hyperlipidemia, obesity, hypertension, depression, and autonomic dysfunction. Very few randomized controlled studies have been done in children with T1DM to examine how modification of these risk factors can affect their CVD.SummaryChildren with T1DM have subclinical CVD and multiple modifiable risk factors for CVD. More research is needed to define how modification of these factors affects the progression of CVD.

Intensive gestational glycemic management and childhood obesity: a systematic review and meta-analysis

“…177,179 In addition, children >7 years of age with type 1 diabetes in the clinical pediatric endocrinology database, prescriptions for insulin pumps, or indications of cystic fibrosis-related diabetes were excluded to further try to restrict to type 2 diabetes (total excluded n = 1609). The conditions above were excluded to limit confounding in the associations between intrauterine exposure to diabetes and CVD risk, as they are known to be associated with CVD risk but are not likely to be caused by the exposure [180][181][182][183][184] except for congenital anomalies, in which case their association with intrauterine exposure is already established (reviewed in 185 ).…”

Skin autofluorescence predicts major adverse cardiovascular events in patients with type 1 diabetes: a 7-year follow-up study

“…Despite the decline of cardiovascular disease in patients with type 1 diabetes (T1D) [ 1 ], it remains by far the first cause of mortality, as recently reported in patients with long duration of diabetes [ 2 ], and a major concern even in children who often present features of subclinical cardiovascular disease [ 3 ]. The cardiovascular risk of subjects with T1D is influenced by modifiable conventional risk factors such as arterial hypertension, dyslipidemia, and smoking, [ 4 ], and is strongly higher in the presence of diabetic nephropathy [ 5 ], but hyperglycaemia by itself is thought to play an important role.…”

Low cholesterol efflux capacity and abnormal lipoprotein particles in youth with type 1 diabetes: a case control study

“…The CVD associated processes starts early in childhood. It is well established that youth with T1DM exhibit early signs of CVD, such as higher blood pressure, arterial stiffness, myocardial and endothelial dysfunction [ 1 – 4 ]. Some of the known risk factors include an abnormal lipoprotein profile, characterized by small Low-density lipoprotein (LDL) particles (LDLp) and small High-density lipoprotein (HDL) particles (HDLp) and a decrease in reverse cholesterol transport i.e.…”