The Impact of Diabetes Mellitus on Cardiovascular Risk Onset in Children and Adolescents

Abstract

The prevalence of diabetes mellitus is rising among children and adolescents worldwide. Cardiovascular diseases are the main cause of morbidity and mortality in diabetic patients. We review the impact of diabetes on establishing, during childhood and adolescence, the premises for cardiovascular diseases later in life. Interestingly, it seems that hyperglycemia is not the only factor that establishes an increased cardiovascular risk in adolescence. Other factors have been recognized to play a role in triggering the onset of latent cardiovascular diseases in the pediatric population. Among these cardiovascular risk factors, some are modifiable: glucose variability, hypoglycemia, obesity, insulin resistance, waist circumference, hypertension, dyslipidemia, smoking alcohol, microalbuminuria and smoking. Others are unmodifiable, such as diabetes duration and family history. Among the etiological factors, subclinical endothelial dysfunction represents one of the earliest key players of atherosclerosis and it can be detected during early ages in patients with diabetes. A better assessment of cardiovascular risk in pediatric population still represents a challenge for clinicians, and thus further efforts are required to properly identify and treat pediatric patients who may suffer from cardiovascular disease later in early adulthood.

Association between Urinary Phthalate Metabolites and Markers of Endothelial Dysfunction in Adolescents and Young Adults

“…The potential confounders consisted of both continuous variables (age, total cholesterol, BMI), and categorical variables (gender, hypertension, diabetes mellitus, smoking status, alcohol consumption, physical activity, and household income). Based on previous research, the abovementioned factors were associated with endothelial dysfunction or microparticles [32][33][34][35][36][37][38]; thus, all factors were selected in the regression model. A natural log transformation was performed for the concentrations of ΣDEHP, MnBP, EMPs, and PMPs.…”

“…To determine total exposure to DEHP, we estimated urinary concentrations of the metabolites by summing the molar concentrations of MEHP, MEHHP, and MEOHP as described in previous research (hereafter referred to as ΣDEHP in μmol/g creatinine) [ 29 , 30 ]; all other phthalate metabolites analyzed in this study are expressed in μg/g creatinine [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. The distribution of different phthalate metabolites according to basic characteristics were analyzed, with urine metabolites concentrations expressed as geometric means and 95% confidence intervals (95% CI).…”

Cardiovascular Disease in Type 1 Diabetes Mellitus: Epidemiology and Management of Cardiovascular Risk

“…The clinical presentation of atherosclerosis occurs at middle age, but the atherosclerotic process begins during childhood and is accelerated by the presence of risk factors [ 26 , 27 , 28 ]. The development of the atherosclerotic process occurs faster in children with T1DM than in non-diabetic children, which probably is related to the increased incidence of other cardiovascular risk factors, such as high blood pressure (HBP), total cholesterol, low density lipoprotein cholesterol (LDL-C), inflammatory markers, and insulin resistance [ 29 ].…”

Sex-Specific Differences in the Relationship between Insulin Resistance and Adiposity Indexes in Children and Adolescents with Obesity

“…Insulin resistance (IR) is a crucial factor contributing to the pathogenetic mechanism of several disorders, including type 2 diabetes mellitus (DMT2), hypertension, dyslipidemia, cardiovascular disease, and metabolic syndrome [1][2][3]. IR represents the earliest manifestation of dysmetabolism in children [4,5].…”