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Early atherosclerosis in childhood type 1 diabetes: role of raised systolic blood pressure in the absence of dyslipidaemia

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Abstract

The intentions of our investigation were (1) to search for atherogenic risk factors and signs of incipient atherosclerosis in children and adolescents with type 1 diabetes (T1DM) in comparison to well-matched control subjects, (2) to evaluate risk factor associations with carotid intima media thickness (cIMT) in diabetic patients and control subjects, and (3) to acquire a better knowledge of early atherogenesis in children and adolescents with and without T1DM. 94 diabetic children (age median 12.3 years, HbA1c median 7.7%) and 40 non-diabetic controls (age median 12.3 years) were investigated. Mean cIMT was determined using high-resolution B-mode ultrasound with an automated contour identification procedure. Compared to controls, subjects with diabetes had significantly elevated cIMT (p = 0.041) and systolic BP (p = 0.007) but showed a less atherogenic lipid profile. Most markers of inflammation, endothelial function and fibrinolytic activity were higher in diabetic subjects than in controls. Multiple linear regression analysis revealed a significant relationship (r = 0.53, p = 0.036) between bilateral mean cIMT and diverse risk factors in patients with T1DM. Spearman rank correlation showed that diabetes duration (rho = 0.32, p = 0.029), systolic BP (rho = 0.32, p = 0.004), weight (rho = 0.257, p = 0.022), and height (rho = 0.265, p = 0.018) significantly correlated with bilateral mean cIMT in the 94 diabetic patients. In conclusion, in well-controlled type 1 diabetic children systolic BP may be of greater importance than dyslipidaemia in early atherogenesis. BMI, markers of sustained inflammation, endothelial dysfunction and fibrinolytic activity are increased in diabetic versus non-diabetic children but none of them correlates significantly with cIMT. Their prognostic value remains to be determined.

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Abbreviations

T1DM:

type 1 diabetes mellitus

BMI-SDS:

body mass index-standard deviation score

BP:

blood pressure

cIMT:

carotid intima-media thickness

CCA:

common carotid artery

CHD:

coronary heart disease

TC:

total cholesterol

TG:

triglycerides

apo B:

apolipoprotein B

hs-CRP:

high sensitive C-reactive protein

vWf:

von Willebrand factor antigen

PAP:

plasmin/α2-antiplasmin complex

PAI:

plasminogen activator inhibitor

ICAM:

intracellular adhesion molecule

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Authors and Affiliations

  1. Department of Pediatrics and Adolescents Medicine, University Hospital, Mathilden Str. 1, 79106, Freiburg, Germany

    Karl Otfried Schwab, Jürgen Doerfer, Andreas Krebs, Elisabeth Schorb, Kristiane Hallermann, Andrea Superti-Furga & Barbara Zieger

  2. Department of Clinical Chemistry, University Hospital, Freiburg, Germany

    Kristin Krebs, Winfried März & Karl Winkler

  3. Department of Preventative and Rehabilitative Sports Medicine, Technical University, Munich, Germany

    Arno Schmidt-Trucksäss

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  1. Karl Otfried Schwab
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  2. Jürgen Doerfer
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Correspondence to Karl Otfried Schwab.

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Schwab, K.O., Doerfer, J., Krebs, A. et al. Early atherosclerosis in childhood type 1 diabetes: role of raised systolic blood pressure in the absence of dyslipidaemia. Eur J Pediatr 166, 541–548 (2007). https://doi.org/10.1007/s00431-007-0440-0

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  • DOI: https://doi.org/10.1007/s00431-007-0440-0

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