CVD Risk Factors Greater in Girls With Type 1 Diabetes

Abstract Context Cardiovascular disease (CVD) is a major cause of mortality in adults with type 1 diabetes. Objective We prospectively evaluated CVD risk factors in a large, contemporary cohort of adults with type 1 diabetes living in the United States. Design Observational study of CVD and CVD risk factors over a median of 5.3 years. Setting The T1D Exchange clinic network. Patients Adults (age ≥ 18 years) with type 1 diabetes and without known CVD diagnosed before or at enrollment. Main Outcome Measure Associations between CVD risk factors and incident CVD were assessed by multivariable logistic regression. Results The study included 8,727 participants (53% female, 88% non-Hispanic white, median age 33 years [interquartile ratio {IQR} = 21, 48], type 1 diabetes duration 16 years [IQR = 9, 26]). At enrollment, median HbA1c was 7.6% (66 mmol/mol) (IQR = 6.9 [52], 8.6 [70]), 33% used a statin, and 37% used blood pressure medication. Over a mean follow-up of 4.6 years, 325 (3.7%) participants developed incident CVD. Ischemic heart disease was the most common CVD event. Increasing age, body mass index, HbA1c, presence of hypertension and dyslipidemia, increasing duration of diabetes, and diabetic nephropathy were associated with increased risk for CVD. There were no significant gender differences in CVD risk. Conclusion HbA1c, hypertension, dyslipidemia and diabetic nephropathy are important risk factors for CVD in adults with type 1 diabetes. A longer follow-up is likely required to assess the impact of other traditional CVD risk factors on incident CVD in the current era.

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Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes

International Journal of Molecular Sciences ◽

10.3390/ijms221910192 ◽

2021 ◽

Vol 22 (19) ◽

pp. 10192

Author(s):

Darja Smigoc Schweiger ◽

Tadej Battelino ◽

Urh Groselj

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Type 1 Diabetes ◽

Children And Adolescents ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Risk Profile ◽

Cvd Risk Factors ◽

Cvd Risk

Cardiovascular disease (CVD) is the primary cause of higher and earlier morbidity and mortality in people with type 1 diabetes (T1D) compared to people without diabetes. In addition, women with T1D are at an even higher relative risk for CVD than men. However, the underlying pathophysiology is not well understood. Atherosclerotic changes are known to progress early in life among people with T1D, yet it is less clear when excess CVD risk begins in females with T1D. This review explores the prevalence of classical CVD risk factors (such as glycemic control, hypertension, dyslipidemia, obesity, albuminuria, smoking, diet, physical inactivity), as well as of novel biomarkers (such as chronic inflammation), in children and adolescents with T1D with particular regard to sex-related differences in risk profile. We also summarize gaps where further research and clearer clinical guidance are needed to better address this issue. Considering that girls with T1D might have a more adverse CVD risk profile than boys, the early identification of and sex-specific intervention in T1D would have the potential to reduce later CVD morbidity and excess mortality in females with T1D. To conclude, based on an extensive review of the existing literature, we found a clear difference between boys and girls with T1D in the presence of individual CVD risk factors as well as in overall CVD risk profiles; the girls were on the whole more impacted.

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Cardiovascular risk factors from diagnosis in children with type 1 diabetes mellitus: a longitudinal cohort study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2018-000625 ◽

2019 ◽

Vol 7 (1) ◽

pp. e000625 ◽

Cited By ~ 4

Author(s):

Stephanie Jones ◽

Amal R Khanolkar ◽

Evelien Gevers ◽

Terence Stephenson ◽

Rakesh Amin

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Density Lipoprotein ◽

Diabetes Duration ◽

Lipoprotein Cholesterol ◽

Cvd Risk Factors ◽

Cvd Risk

BackgroundFor childhood onset type 1 diabetes (T1D), the pathogenesis of atherosclerosis is greatly accelerated and results in early cardiovascular disease (CVD) and increased mortality. However, cardioprotective interventions in this age group are not routinely undertaken.AimsTo document prevalence of cardiovascular risk factors from diagnosis of childhood T1D and their relationship with disease duration and ethnicity.MethodsRoutinely collected clinical records for 565 children with T1D were retrospectively analyzed. Data were collected from diagnosis and at routine check-ups at pediatric diabetes clinics across Barts Health National Health Service Trust. Age at diagnosis was 8.5 years (0.9–19.4). Mean follow-up 4.3 years (0–10.8). 48% were boys and 60% were non-white. Linear longitudinal mixed effects models were used to evaluate relationships between risk factors and diabetes duration.ResultsCVD risk factors were present at first screening; 33.8% of children were overweight or obese, 20.5% were hypertensive (elevated diastolic blood pressure (BP)) and total cholesterol, low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol were abnormal in 63.5%, 34.2% and 22.0%, respectively. Significant associations between diabetes duration and annual increases of body mass index (0.6 kg/m2), BP (0.1 SD score) and lipids (0.02–0.06 mmol/L) were noted. Annual increases were significantly higher in black children for BP and Bangladeshi children for lipids. Bangladeshi children also had greatest baseline levels.ConclusionsCVD risk factors are present in up to 60% of children at diagnosis of T1D and increase in prevalence during the early years of the disease. Commencing screening in younger children and prioritizing appropriate advice and attention to ethnic variation when calculating risk should be considered.

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Adherence to physical activity recommendations and barriers to physical activity participation among adults with type 1 diabetes

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02741-w ◽

2021 ◽

Author(s):

Mary Finn ◽

Mark Sherlock ◽

Sinead Feehan ◽

Emer M. Guinan ◽

Kevin B. Moore

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Type 1 Diabetes ◽

Accurate Information ◽

Linear Regression Models ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Cross Sectional ◽

Barriers To Physical Activity

Abstract Background Physical activity (PA) is important for those with type 1 diabetes (T1DM); however, accurate information on PA in people with T1DM is limited. Aims This study assessed adherence to PA guidelines using both objective and subjective PA measures and evaluated the relationship between accelerometer-measured PA and cardiovascular disease (CVD) risk factors. Barriers to PA were also assessed. Methods Using an observational cross-sectional design, PA was measured objectively over 7 days in 72 participants (34 males) using an accelerometer (ActiGraph) and subjectively using the International Physical Activity Questionnaire (IPAQ). Perceived barriers to PA were assessed using the Barriers to Physical Activity in Diabetes (type 1) scale. Multiple linear regression models assessed the influence of PA on HbA1c and CVD risk factors. Results Mean age ± SD was 40.9 ± 12.9 years, diabetes duration was 18 ± 11.6 years, and HbA1c was 65 ± 14 mmol/mol /8.0 ± 1.3%. Twenty-three (32%) participants exercised according to PA recommendations as measured by an accelerometer. Sixty-nine (97%) participants reported meeting the recommendations as per the IPAQ. Those meeting recommendations (accelerometry) had a lower HbA1c (p = 0.001), BMI (p = 0.032), waist circumference (p = 0.006), and fat mass (p = 0.032) and a greater number of hypoglycaemic events (p = 0.004). Fear of hypoglycaemia was the strongest barrier to PA (mean 3.4 ± 2.0). Conclusion The majority of participants failed to meet PA recommendations. Meeting the recommendations was associated with healthier CVD risk factor profiles. Individuals with T1DM possibly overestimate their PA using self-reported measures and require support and education to safely improve activity levels.

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30-Year Cardiovascular Disease in Type 1 Diabetes: Risk and Risk Factors Differ by Long-Term Patterns of Glycemic Control

10.2337/figshare.16775965 ◽

2021 ◽

Author(s):

Rachel G. Miller ◽

Trevor J. Orchard ◽

Tina Costacou

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Latent Class ◽

Diabetes Duration ◽

Cvd Risk ◽

High Hba1c

Objective: We hypothesized that there is heterogeneity in long-term patterns of glycemic control with respect to cardiovascular disease (CVD) development in type 1 diabetes and that risk factors for CVD differ by glycemic control pattern. Thus, we estimated associations between data-derived latent HbA1c trajectories and 30-year CVD risk in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset (<17 years old) type 1 diabetes. Research Design and Methods: Participants (n=536 with ≥2 HbA1c measurements [median 6] and CVD-free at baseline; mean age 27 and diabetes duration 18 years) were followed from 1986-88 to 2016-18 to ascertain CVD incidence (CVD death, myocardial infarction, stroke, coronary revascularization or blockage ≥50%, ischemic ECG, or angina). Latent HbA1c trajectories and their association with time-to-CVD incidence were simultaneously assessed using Joint Latent Class Mixed Models. Results: Two HbA1c trajectories with respect to differential CVD risk were identified: Low (HbA1c ~8% [64 mmol/mol] and improving over follow-up, 76% of cohort) and High (HbA1c ~10% [86 mmol/mol] and stable, 24%). Overall, 30-year CVD incidence was 47.4% (n=253); MACE incidence 31.0% (n=176). High HbA1c was associated with 3-fold increased CVD risk versus Low HbA1c. Both groups had similar age and diabetes duration. Non-HDLc and estimated glomerular filtration rate were associated with CVD risk only in Low HbA1c; albumin excretion rate was associated with CVD risk only in High HbA1c. Conclusions: These risk factor differences suggest that pathways to CVD may differ by glycemic control, potentially resulting in important implications for prognosis in type 1 diabetes.

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Abstract P335: The Number of Coronary Arteries with Calcified Plaque is Increased in Type 1 Diabetes

Circulation ◽

10.1161/circ.129.suppl_1.p335 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Lindsey M Duca ◽

Gregory L Kinney ◽

Amy C Alman ◽

Janet K Snell-Bergeon

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Coronary Arteries ◽

Subclinical Atherosclerosis ◽

Multivariable Analysis ◽

Agatston Score ◽

Cvd Risk ◽

Calcified Plaque ◽

Chi Square Analysis

Adults with type 1 diabetes (T1D) have a higher risk for cardiovascular disease than non-diabetic (non-DM) adults. Coronary artery calcification (CAC) is a marker for subclinical atherosclerosis and the Agatston CAC score is the standard used today. The aim of our study was to look at the number of coronary arteries with calcified plaques to determine if more diffuse disease is present in adults with T1D for a given level of CAC. In addition, we examined risk factors associated with the number of coronary arteries with CAC, as this could be a novel way to risk-stratify individuals. This study consisted of 1169 participants (T1D n=535 and non-DM n =634) with a mean ± SD age of 39±9 years. CAC was measured by electron beam CT (EBCT) using two scans performed five minutes apart and the maximum number of coronary arteries with CAC was used in the analysis. CAC lesions were determined in the left main, left anterior descending, circumflex, and right coronary arteries, with a maximum number of arteries with CAC ranging from zero to four. Chi square analysis was used to compare the number of coronary arteries with CAC by diabetes group. Subjects were then divided into categories based on their CAC score (>0-10, 10-100, >100-300, >300) and poisson regression was used in multivariable analysis to examine associated risk factors. Adults with T1D had a significantly higher number of coronary arteries with CAC lesions than the non-DM adults (p > 0.0001). Among subjects with CAC>300 (n=58), adults with T1D had more coronary arteries with CAC than the controls (p = 0.03), but there were no differences in number of arteries with CAC among the other Agatston score categories. In multivariable analysis, HDL and LDL cholesterol, BMI, and hypertension were all independently associated with the number of coronary arteries with CAC lesions when adjusting for age, diabetes and CAC score (p<0.0001). There were no significant associations of number of arteries with CAC with smoking status or hemoglobin A1c. People with T1D were still significantly more likely to have more coronary arteries with CAC lesions than non-DM individuals after adjusting for the above factors. In conclusion, T1D patients have more diffuse subclinical atherosclerosis, as indicated by a greater number of coronary arteries with CAC compared with non-DM adults. The number of coronary arteries with calcified plaque was independently associated with traditional CVD risk factors, even when accounting for CAC score. These findings are important because traditionally just the Agatston CAC score is used to determine CVD risk, but the number of coronary arteries affected could indicate how diffuse the subclinical artherosclerosis is prompt for aggressive treatment of traditional risk factors.

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Abstract P196: Unhealthful Dietary Intake Pattern Identified by Reduced Rank Regression is Associated with Increased Arterial Stiffness among Youth with Type 1 Diabetes

Circulation ◽

10.1161/circ.129.suppl_1.p196 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Archana P Lamichhane ◽

Angela D Liese ◽

Elaine M Urbina ◽

Jamie L Crandell ◽

Lindsay M Jaacks ◽

...

Keyword(s):

Risk Factors ◽

Dietary Pattern ◽

Risk Profile ◽

Cvd Risk Factors ◽

Reduced Rank Regression ◽

Cvd Risk ◽

Rank Regression ◽

Reduced Rank ◽

Diet Soda

Introduction: Youth with type 1 diabetes (T1DM) are at substantially increased risk for adverse vascular outcomes, but little is known about the influence of dietary behavior on cardiovascular disease (CVD) risk profile and outcomes. Objective: We applied reduced rank regression (RRR) to identify a specific dietary pattern that explained the maximum amount of variation in CVD risk factors, and was strongly associated with markers of arterial stiffness (AS) in a cohort of youth with T1DM. Methods: Baseline diet data from a food frequency questionnaire and CVD risk factors (triglycerides, LDL-cholesterol, systolic blood pressure, hemoglobin A1c, C-reactive protein and waist circumference) were available for 1,153 youth aged ≥10 years with T1DM from the SEARCH for Diabetes in Youth Study. Dietary intake patterns were identified using 33 food-groups as predictors and six CVD risk factors as responses in an RRR analysis. AS outcomes were measured on average 18.9±7.1 months after the baseline diet assessment and were available only in a subset of participants from the SEARCH CVD pilot study. Associations between the RRR-derived dietary pattern explaining the maximum variation in CVD risk factors and AS measures [augmentation index(AIx75),n=229; pulse wave velocity(PWV),n=237; and brachial distensibility(BrachD),n=228] were then assessed using linear regression. Results: The RRR-derived pattern of interest was characterized by high intakes of sugar-sweetened beverages (SSB) and diet soda, eggs, potatoes and high-fat meats, and low intakes of sweets/desserts and low-fat dairy; major contributors were SSB and diet soda. This pattern captured the largest variability in the adverse CVD risk profile and was subsequently positively associated with AIx75 in the final model (β=0.47; p<0.01). The mean difference in AIx75 concentration between the highest and the lowest dietary pattern quartiles was 4.3% in fully adjusted model. Associations of the dietary pattern with the other measures of AS, PWV and BrachD, were attenuated and became non-significant after adjustment for potential confounders. Conclusions: Intervention strategies to reduce consumption of unhealthful foods and beverages among youth with T1DM may significantly improve CVD risk profile and ultimately reduce the risk for AS. Future studies with larger samples are needed to explore the associations between the derived dietary pattern and other measures of AS (PWV and BrachD), which can provide further insights into possible pathways linking diet to AS in this high risk population.

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Preventing Cardiovascular Complications in Type 1 Diabetes: The Need for a Lifetime Approach

Frontiers in Pediatrics ◽

10.3389/fped.2021.696499 ◽

2021 ◽

Vol 9 ◽

Author(s):

Scott T. Chiesa ◽

M. Loredana Marcovecchio

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Treatment Strategies ◽

Critical Time ◽

Cardiovascular Complications ◽

Pharmacological Intervention ◽

Cvd Risk ◽

Increased Risk

Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in individuals with type 1 diabetes (T1D). Adolescence appears to be a critical time for the development of early subclinical manifestations of CVD, with these changes likely driven by a deterioration in glycemic control during the progression through puberty, combined with the emergence of numerous other traditional cardiometabolic risk factors (e.g., hypertension, dyslipidemia, smoking, alcohol use, obesity, etc.) which emerge at this age. Although hemoglobin A1C has long been the primary focus of screening and treatment strategies, glycemic control remains poor in youth with T1D. Furthermore, screening for cardiovascular risk factors—which are often elevated in youth with T1D—is suboptimal, and use of pharmacological interventions for hypertension and dyslipidemia remains low. As such, there is a clear need not only for better screening strategies for CVD risk factors in youth, but also early interventions to reduce these, if future CVD events have to be prevented. Accumulating evidence has recently suggested that early increases in urinary albumin excretion, even within the normal range, may identify adolescents with T1D who are at an increased risk of complications, and results from pharmacological intervention with statins and ACE inhibitors in these individuals have been encouraging. These data join a growing evidence highlighting the need for a whole-life approach to prevention starting from childhood if efforts to improve CVD outcomes and related mortality in T1D are to be maintained.

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Genetic Risk Factors for CVD in Type 1 Diabetes: the DCCT/EDIC Study

10.2337/figshare.14182715 ◽

2021 ◽

Author(s):

Ionut Bebu ◽

Sareh Keshavarzi ◽

Xiaoyu Gao ◽

Barbara H. Braffett ◽

Angelo J. Canty ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Type 1 Diabetes ◽

Genetic Factors ◽

Risk Scores ◽

Major Adverse Cardiovascular Events ◽

Cvd Risk ◽

Individual Snps

Background The role of genetic factors on the risk of cardiovascular disease (CVD) risk in type 1 diabetes remains unknown. We therefore examined whether previously identified genetic factors for coronary artery disease (CAD) are associated with the risk of CVD above and beyond established demographic and clinical factors in The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study. Methods Polygenic risk scores (PRS) and individual genetic variants identified in previous studies were obtained from genome-wide genotyping performed in 1371 DCCT/EDIC participants. Two composite CVD outcomes were considered: major adverse cardiovascular events (MACE) (CVD death or non-fatal myocardial infarction or stroke) and any-CVD (MACE plus confirmed angina, silent MI, revascularization, or congestive heart failure). Cox proportional hazards models assessed the association between the genetic factors and the risk of CVD when adjusted for other factors (including age, lipids, blood pressure and glycemia). Results CAD PRS was strongly associated with the subsequent risk of any-CVD (42% and 38% higher risk per 1 standard deviation (SD) increase in unadjusted and fully adjusted models, respectively, p<0.0001), and with the risk of MACE (50% and 40% higher risk per 1SD increase in unadjusted and fully adjusted models, respectively, p<0.0001). Several individual SNPs were also nominally associated with the risk of any-CVD and MACE. Conclusions Genetic factors are associated with the risk of subsequent cardiovascular disease in individuals with type 1 diabetes, above and beyond the effect of established risk factors such as age, lipids, blood pressure and glycemia.

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The Problem of Abnormal Body Weight and Dyslipidemia as Risk Factors for Cardiovascular Diseases in Children and Adolescents with Type 1 Diabetes

Journal of Diabetes Research ◽

10.1155/2021/5555149 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Katarzyna Noras ◽

Ewa Rusak ◽

Przemysława Jarosz-Chobot

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Cardiovascular Diseases ◽

Children And Adolescents ◽

Density Lipoprotein ◽

Predictive Biomarkers ◽

Healthy Population ◽

Cvd Risk ◽

Apo B

Diabetes is a disease that affects many people around the world. Its complications are the cause of cardiovascular diseases (CVD) and increased mortality. That is why the search for predictive biomarkers is so important. The aim of the study was to show the prevalence of the problem and risk factors in children and adolescents with type 1 diabetes. These patients are often overweight and obese, and the percentage of lipid disorders is particularly high. The discussed markers of CVD risk in type 1 diabetes include apolipoproteins (apo-B and apo-C3), modified forms of LDL, and the role of high-density lipoprotein (HDL). Recently, a new look at the vasoprotective effect of HDL has appeared, which due to its dysfunctional form in type 1 diabetes may not protect against cardiovascular risk. The HDL proteome in type 1 diabetes has an altered protein composition compared to the healthy population. Another direction of research is determining the importance of trace elements (mainly Mg) in the development of diabetes complications.

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