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

Cardiovascular disease (CVD) is a major cause of mortality in type 1 diabetes mellitus (T1DM) patients, and cardiovascular risk (CVR) remains high even in T1DM patients with good metabolic control. The underlying mechanisms remain poorly understood and known risk factors seem to operate differently in T1DM and type 2 diabetes mellitus (T2DM) patients. However, evidence of cardiovascular risk assessment and management in T1DM patients often is extrapolated from studies on T2DM patients or the general population. In this review, we examine the existing literature about the prevalence of clinical and subclinical CVD, as well as current knowledge about potential risk factors involved in the development and progression of atherosclerosis in T1DM patients. We also discuss current approaches to the stratification and therapeutic management of CVR in T1DM patients. Chronic hyperglycemia plays an important role, but it is likely that other potential factors are involved in increased atherosclerosis and CVD in T1DM patients. Evidence on the estimation of 10-year and lifetime risk of CVD, as well as the efficiency and age at which current cardiovascular medications should be initiated in young T1DM patients, is very limited and clearly insufficient to establish evidence-based therapeutic approaches to CVD management.

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Cardiovascular risk factors in children with type 1 diabetes mellitus

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2018-0382 ◽

2019 ◽

Vol 32 (7) ◽

pp. 699-705 ◽

Cited By ~ 4

Author(s):

Ying Zhang ◽

Han Zhang ◽

Pin Li

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Cardiovascular Disease ◽

Type 1 Diabetes ◽

Cardiovascular Risk ◽

Type 1 Diabetes Mellitus ◽

Cardiovascular Risk Factors ◽

Density Lipoprotein ◽

Diabetic Children

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.

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