In 2010, the American Heart Association (AHA) identified national goals for ideal cardiovascular health (ICH). Type 1 diabetes (T1D) significantly increases the risk of cardiovascular disease (CVD), and adolescents with T1D are a group particularly relevant for focus on ICH. The purpose of this study was to examine the prevalence of ICH in a population of adolescents with T1D and to examine the association of ICH with measures of CV function [arterial stiffness (AS) measured using pulse-wave velocity (PWV), augmentation index (AIX) and brachial distensibility (BD)], and structure [carotid intima-media thickness (cIMT; bulb, common carotid (CC), and internal carotid (IC))].
We used data from the retrospective cohort component of the SEARCH CVD study, which followed youth with T1D for approximately 6 years. Data collected at baseline (mean age 15 years) include diet, smoking, physical activity, BMI, cholesterol, blood pressure, and fasting plasma glucose. Measures of PWV, AIX, BD, and cIMT were obtained at follow-up (mean age 20 years, diabetes duration 10 years). Complete data were available on 182 subjects. Multiple linear regression models were fit to examine the association between the Number of metrics that met the ICH goal (NICH; range 0 to 7) and the subclinical CVD outcomes.
The prevalence of the ICH metrics is shown in Table 1. Prevalence of ICH ranges from none meeting the healthy diet to nearly all being never smokers (88%). While most youth met 3 or 4 goals, only 5% met 5 and none met all 7 criteria. Increasing NICH at baseline was associated with lower AS [lower PWV (β= -0.02, p=0.035), higher BD (β= 0.03, p=0.042)] and lower cIMT of the CC (β= -0.02, p=0.023), adjusted for age, sex, race, hemoglobin A1c, triglycerides, and diabetes duration.
In conclusion, youth with T1D are not meeting ICH goals. Meeting more ICH goals was associated with better CV health as indicated by lower AS and cIMT thickness. Measures targeted at increasing ICH in adolescents with T1D are needed in order to reduce the burden of CVD in this high risk population.
Diabetes Distress, Depressive Symptoms, and Cardiovascular Health in Adults With Type 1 Diabetes