Cardiovascular risk factors in children with type 1 diabetes mellitus
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Ying Zhang
Abstract
Objective
Cardiovascular disease is a major complication among children with type 1 diabetes mellitus (T1DM). This prospective study aimed at examining the presence of cardiovascular risk factors in children with T1DM.
Methods
We evaluated several cardiovascular risk factors, including atherosclerosis, artery intima-media thickness (IMT) and metabolic responses, in 175 children with T1DM, with 150 non-diabetic children as normal controls.
Results
The diabetic children had significantly higher carotid IMT (cIMT) and aortic IMT (aIMT), higher values for diastolic wall stress (DWS), incremental elastic modulus (IEM), and flow-mediated dilatation (FMD) than the controls. The levels of tumor necrosis factor-α (TNF-α), interleukin-4 (IL4), high-sensitivity C-reactive protein (hs-CRP) and leptin were significantly higher in T1DM patients. In T1DM children, the cIMT and aIMT were correlated with several risk factors, including age, weight, body mass index (BMI), duration of diabetes, waist/hip ratio, as well as levels of total cholesterol, triglycerides and apolipoprotein B (apoB). In addition to common risk factors, cIMT was also associated with systolic blood pressure (BP). Other risk factors, such as height, diastolic BP, low-density lipoprotein (LDL)/high-density lipoprotein (HDL)-cholesterol ratio, apolipoprotein A1 (apoA1) and S-creatinine levels, were not all independent risk factors of cardiovascular disease in T1DM children.
Conclusions
T1DM is associated with early impairment of the common carotid and aortic artery structure and function, and the diabetic state may be the main risk factor for arterial wall stiffening and thickening.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: This research was supported by Subject from the Shanghai Municipal Commission of Health and Family Planning (No. 20174Y0007), joint public relations project of emerging cutting-edge technologies of municipal hospitals (No. SHDC12015111), and by Special Subject from the research on prevention and control of major chronic non-communicable diseases of the National Key Research and Development Program (No. 2016YFC1305300).
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Van Merode T, Van Bortel L, Smeets FA, Böhm R, Mooij J, et al. The effect of verapamil on carotid artery distensibility and cross-sectional compliance in hypertensive patients. J Cardiovasc Pharmacol 1990;15:109–13.10.1097/00005344-199001000-00017Suche in Google Scholar PubMed
2. Chen CK, Cifra B, Morgan GJ, Sarkola T, Slorach C, et al. Left ventricular myocardial and hemodynamic response to exercise in young patients after endovascular stenting for aortic coarctation. J Am Soc Echocardiogr 2016;29:237–46.10.1016/j.echo.2015.11.017Suche in Google Scholar PubMed
3. Karpoff L, Vinet A, Schuster I, Oudot C, Goret L, et al. Abnormal vascular reactivity at rest and exercise in obese boys. Eur J Clin Invest 2009;39:94–102.10.1111/j.1365-2362.2008.02068.xSuche in Google Scholar PubMed
4. Aggoun Y, Colomb V, Turanlahti M, Corriol O, Goulet O, et al. Endothelial function and mechanical properties of the common carotid artery in children on parenteral nutrition. Pediatr Res 2004;55:789–93.10.1203/01.PDR.0000115680.46755.F5Suche in Google Scholar PubMed
5. Gazolla FM, Neves Bordallo MA, Rey Madeira I, de Miranda Carvalho CN, Vieira Monteiro AM, et al. Association between cardiovascular risk factors and carotid intima-media thickness in prepubertal Brazilian children. J Pediatr Endocrinol Metab 2015;28:579–87.10.1515/jpem-2014-0116Suche in Google Scholar PubMed
6. Mooij CF, van Herwaarden AE, Sweep FC, Roeleveld N, de Korte CL, et al. Cardiovascular and metabolic risk in pediatric patients with congenital adrenal hyperplasia due to 21 hydroxylase deficiency. J Pediatr Endocrinol Metab 2017;30:957–66.10.1515/jpem-2017-0068Suche in Google Scholar PubMed
7. Walch L, Massade L, Dufilho M, Brunet A, Rendu F. Pro-atherogenic effect of interleukin-4 in endothelial cells: modulation of oxidative stress, nitric oxide and monocyte chemoattractant protein-1 expression. Atherosclerosis 2006;187:285–91.10.1016/j.atherosclerosis.2005.09.016Suche in Google Scholar PubMed
8. Satoh N, Naruse M, Usui T, Tagami T, Suganami T, et al. Leptin-to-adiponectin ratio as a potential atherogenic index in obese type 2 diabetic patients. Diabetes Care 2004;27:2488–90.10.2337/diacare.27.10.2488Suche in Google Scholar PubMed
9. Di Tomo P, Lanuti P, Di Pietro N, Baldassarre MP, Marchisio M, et al. Liraglutide mitigates TNF-alpha induced pro-atherogenic changes and microvesicle release in HUVEC from diabetic women. Diabetes Metab Res Rev 2017;33:e2925.10.1002/dmrr.2925Suche in Google Scholar PubMed
10. Wang RY, Braunlin EA, Rudser KD, Dengel DR, Metzig AM, et al. Carotid intima-media thickness is increased in patients with treated mucopolysaccharidosis types I and II, and correlates with arterial stiffness. Mol Genet Metab 2014;111:128–32.10.1016/j.ymgme.2013.11.001Suche in Google Scholar PubMed PubMed Central
11. Gomez-Diaz RA, Ramírez-Soriano E, Tanus Hajj J, Bautista Cruz E, Jiménez Galicia C, et al. Association between carotid intima-media thickness, buccodental status, and glycemic control in pediatric type 1 diabetes. Pediatr Diabet 2012;13:552–8.10.1111/j.1399-5448.2012.00868.xSuche in Google Scholar
12. Oyre S, Paaske WP, Ringgaard S, Kozerke S, Erlandsen M, et al. Automatic accurate non-invasive quantitation of blood flow, cross-sectional vessel area, and wall shear stress by modelling of magnetic resonance velocity data. Eur J Vasc Endovasc Surg 1998;16:517–24.10.1016/S1078-5884(98)80244-XSuche in Google Scholar
13. Aggoun Y, Bonnet D, Sidi D, Girardet JP, Brucker E, et al. Arterial mechanical changes in children with familial hypercholesterolemia. Arterioscler Thromb Vasc Biol 2000;20:2070–5.10.1161/01.ATV.20.9.2070Suche in Google Scholar
14. Atabek ME, Kurtoglu S, Pirgon O, Baykara M. Arterial wall thickening and stiffening in children and adolescents with type 1 diabetes. Diabetes Res Clin Pract 2006;74:33–40.10.1016/j.diabres.2006.03.004Suche in Google Scholar PubMed
15. Masoura C, Pitsavos C, Aznaouridis K, Skoumas I, Vlachopoulos C, et al. Arterial endothelial function and wall thickness in familial hypercholesterolemia and familial combined hyperlipidemia and the effect of statins. A systematic review and meta-analysis. Atherosclerosis 2011;214:129–38.10.1016/j.atherosclerosis.2010.10.008Suche in Google Scholar PubMed
16. Orsag J, Karasek D, Halenka M, Vaverkova H, Spurna J, et al. Association of serum adipocyte fatty acid-binding protein and apolipoprotein B/apolipoprotein A1 ratio with intima media thickness of common carotid artery in dyslipidemic patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018. doi: 10.5507/bp.2018.043 [Epub ahead of print].Suche in Google Scholar PubMed
17. McLeod O, Silveira A, Fredrikson GN, Gertow K, Baldassarre D, et al. Plasma autoantibodies against apolipoprotein B-100 peptide 210 in subclinical atherosclerosis. Atherosclerosis 2014;232:242–8.10.1016/j.atherosclerosis.2013.11.041Suche in Google Scholar PubMed
18. Mosleh W, Elango K, Shah T, Chaudhari M, Gandhi S, et al. Elevated end-diastolic wall stress after acute myocardial infarction predicts adverse cardiovascular outcomes and longer hospital length of stay. Echocardiography 2018;35:1721–8.10.1111/echo.14136Suche in Google Scholar PubMed
19. Alter P, Koczulla AR, Nell C, Figiel JH, Vogelmeier CF, et al. Wall stress determines systolic and diastolic function--Characteristics of heart failure. Int J Cardiol 2016;202:685–93.10.1016/j.ijcard.2015.09.032Suche in Google Scholar PubMed
20. Gu H, Li Y, Fok H, Simpson J, Kentish JC, et al. Reduced first-phase ejection fraction and sustained myocardial wall stress in hypertensive patients with diastolic dysfunction: a manifestation of impaired shortening deactivation that links systolic to diastolic dysfunction and preserves systolic ejection fraction. Hypertension 2017;69:633–40.10.1161/HYPERTENSIONAHA.116.08545Suche in Google Scholar PubMed PubMed Central
21. Rosa JS, Flores RL, Oliver SR, Pontello AM, Zaldivar FP, et al. Sustained IL-1alpha, IL-4, and IL-6 elevations following correction of hyperglycemia in children with type 1 diabetes mellitus. Pediatr Diabetes 2008;9:9–16.10.1111/j.1399-5448.2007.00243.xSuche in Google Scholar PubMed
22. Galli-Tsinopoulou A, Maggana I, Kyrgios I, Mouzaki K, Grammatikopoulou MG, et al. Association between magnesium concentration and HbA1c in children and adolescents with type 1 diabetes mellitus. J Diabetes 2014;6:369–77.10.1111/1753-0407.12118Suche in Google Scholar PubMed
23. Furuya A, Suzuki S, Koga M, Oshima M, Amamiya S, et al. HbA1c can be a useful glycemic control marker for patients with neonatal diabetes mellitus older than 20 weeks of age. Clin Chim Acta 2014;436:93–6.10.1016/j.cca.2014.05.005Suche in Google Scholar PubMed
24. Ersoy M, Selcuk Duru HN, Elevli M, Ersoy O, Civilibal M. Aortic intima-media thickness and mean platelet volume in children with type 1 diabetes mellitus. Iran J Pediatr 2015;25:e368.10.5812/ijp.368Suche in Google Scholar PubMed PubMed Central
25. Juonala M, Viikari JS, Laitinen T, Marniemi J, Helenius H, et al. Interrelations between brachial endothelial function and carotid intima-media thickness in young adults: the cardiovascular risk in young Finns study. Circulation 2004;110:2918–23.10.1161/01.CIR.0000147540.88559.00Suche in Google Scholar PubMed
26. Takeuchi D, Furutani M, Harada Y, Furutani Y, Inai K, et al. High prevalence of cardiovascular risk factors in children and adolescents with Williams-Beuren syndrome. BMC Pediatr 2015;15:126.10.1186/s12887-015-0445-1Suche in Google Scholar PubMed PubMed Central
27. Homma Y, Hayabuchi Y, Terada T, Inoue M, Mori K. Early diastolic left ventricular relaxation in normal neonates is influenced by ventricular stiffness and longitudinal systolic function. Int Heart J 2018;59:149–53.10.1536/ihj.17-125Suche in Google Scholar PubMed
28. Choi J, Kang MK, Han C, Hwang SM, Jung SG, et al. Lower diastolic wall strain is associated with coronary revascularization in patients with stable angina. BMC Cardiovasc Disord 2017;17:301.10.1186/s12872-017-0739-3Suche in Google Scholar PubMed PubMed Central
29. Kamimura D, Suzuki T, Hall ME, Wang W, Winniford MD, et al. Diastolic wall strain is associated with incident heart failure in African Americans: insights from the atherosclerosis risk in communities study. J Cardiol 2018;71:477–83.10.1016/j.jjcc.2017.11.004Suche in Google Scholar PubMed PubMed Central
30. Nansel TR, Laffel LM, Haynie DL, Mehta SN, Lipsky LM, et al. Improving dietary quality in youth with type 1 diabetes: randomized clinical trial of a family-based behavioral intervention. Int J Behav Nutr Phys Act 2015;12:58.10.1186/s12966-015-0214-4Suche in Google Scholar PubMed PubMed Central
31. Rosa JS, Oliver SR, Flores RL, Ngo J, Milne GL, et al. Altered inflammatory, oxidative, and metabolic responses to exercise in pediatric obesity and type 1 diabetes. Pediatr Diabetes 2011;12:464–72.10.1111/j.1399-5448.2010.00724.xSuche in Google Scholar PubMed PubMed Central
©2019 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Review
- Effect of safflower yellow on early type II diabetic nephropathy: a systematic review and meta-analysis of randomized controlled trials
- Original Articles
- Genomic study via chromosomal microarray analysis in a group of Romanian patients with obesity and developmental disability/intellectual disability
- Clinical and molecular characteristics and time of diagnosis of patients with classical galactosemia in an unscreened population in Turkey
- Assessment of retinal thickness as a marker of brain masculinization in children with congenital adrenal hyperplasia: a pilot study
- Auditory event-related potentials demonstrate early cognitive impairment in children with subclinical hypothyroidism
- Cardiovascular risk factors in children with type 1 diabetes mellitus
- The relationship between serum FGF-23 concentration and insulin resistance, prediabetes and dyslipidemia in obese children and adolescents
- The metabolic consequences of overweight in a cohort of children with type 1 diabetes
- The spectrum of pediatric adrenal insufficiency: insights from 34 years of experience
- Growth screening in children aged 3–5 years: a useful tool for public health programs in community pediatrics
- Selective receptor-mediated impairment of growth factor activity in neonatal- and X-linked adrenoleukodystrophy patients
- Determinants for low bone mineral density in pre-school children: a matched case-control study in Wuhan, China
- Genetic polymorphisms associated with obesity and non-alcoholic fatty liver disease in Asian Indian adolescents
- Maturity onset diabetes of the young (MODY) in Chinese children: genes and clinical phenotypes
- Severe, persistent neonatal hypoglycemia as a presenting feature in patients with congenital hypopituitarism: a review of our case series
- Case Reports
- Short stature in a boy with atypical progeria syndrome due to LMNA c.433G>A [p.(Glu145Lys)]: apparent growth hormone deficiency but poor response to growth hormone therapy
- A novel mutation leading to the lethal form of carnitine palmitoyltransferase type-2 deficiency
- Diagnosis of cyclic Cushing’s disease manifests as early morning hyperglycemia in a patient with previously well-controlled type 1 diabetes
- Short Communication
- Replacement of breastfeeding with medical food for the treatment of galactosemia and phenylketonuria: maternal stress
Artikel in diesem Heft
- Frontmatter
- Review
- Effect of safflower yellow on early type II diabetic nephropathy: a systematic review and meta-analysis of randomized controlled trials
- Original Articles
- Genomic study via chromosomal microarray analysis in a group of Romanian patients with obesity and developmental disability/intellectual disability
- Clinical and molecular characteristics and time of diagnosis of patients with classical galactosemia in an unscreened population in Turkey
- Assessment of retinal thickness as a marker of brain masculinization in children with congenital adrenal hyperplasia: a pilot study
- Auditory event-related potentials demonstrate early cognitive impairment in children with subclinical hypothyroidism
- Cardiovascular risk factors in children with type 1 diabetes mellitus
- The relationship between serum FGF-23 concentration and insulin resistance, prediabetes and dyslipidemia in obese children and adolescents
- The metabolic consequences of overweight in a cohort of children with type 1 diabetes
- The spectrum of pediatric adrenal insufficiency: insights from 34 years of experience
- Growth screening in children aged 3–5 years: a useful tool for public health programs in community pediatrics
- Selective receptor-mediated impairment of growth factor activity in neonatal- and X-linked adrenoleukodystrophy patients
- Determinants for low bone mineral density in pre-school children: a matched case-control study in Wuhan, China
- Genetic polymorphisms associated with obesity and non-alcoholic fatty liver disease in Asian Indian adolescents
- Maturity onset diabetes of the young (MODY) in Chinese children: genes and clinical phenotypes
- Severe, persistent neonatal hypoglycemia as a presenting feature in patients with congenital hypopituitarism: a review of our case series
- Case Reports
- Short stature in a boy with atypical progeria syndrome due to LMNA c.433G>A [p.(Glu145Lys)]: apparent growth hormone deficiency but poor response to growth hormone therapy
- A novel mutation leading to the lethal form of carnitine palmitoyltransferase type-2 deficiency
- Diagnosis of cyclic Cushing’s disease manifests as early morning hyperglycemia in a patient with previously well-controlled type 1 diabetes
- Short Communication
- Replacement of breastfeeding with medical food for the treatment of galactosemia and phenylketonuria: maternal stress
