Predictors of early atherosclerosis in young patients with type 1 diabetes

الملخص EN

Cardiovascular disease and the development of coronary artery disease play a pivotal role in increasing mortality in patients with diabetes.

The aim of the present study was to determine the presence of subclinical atherosclerosis (measured as carotid intima-media thickness [cIMT] and to study possible associated risk factors in children and adolescents with type 1 diabetes.

Forty type 1 diabetic subjects, were recruited from the Diabetic Endocrine Metabolic Pediatric Unit, Children's Hospital, Cairo University.

Tfieir age ranged from 11-18 yr, while duration of diabetes ranged from 3-15 yr.

Forty normal healthy subjects, matched for age, sex and body mass index (BM1) with patients were included as controls.

Detailed history, stressing on family history of type 2 diabetes, clinical examination, including anthropometry, Blood pressure (BP) measurement, as well as screening for diabetic complications, such as retinopathy, nephropathy, peripheral neuropathy and cardiovascular autonomic neuropathy, were performed.

Lipid profile, albumin / creatinine ratio, renal functions and glycosylated hemoglobin (HB Ale) were assayed.

Carotid intima media thickness (cIMT) was measured using ultrasound in patients and controls.

Tiie mean aggregate cIMT was higher in diabetics than controls (0.6 mm ±0.1 vs 0.4 mm ± 0.1, p = ,0.001 ).

Moreover, it was higher in patients with positive family history of type 2 diabetes than in those with negative family history (mean 0.7 mm ± 0.1 vs 0.6 mm ± 0.1, p= 0.018).

In diabetics, mean aggregate cIMT positively correlated with duration of diabetes (r = 0.66, p = 0.000), systolic blood pressure (r = 0.82, p = 0.000), diastolic BP (r-0.83, p = 0.000), as well as HBAlc (r = 0.40, p = 0.004) and correlated negatively with high density lipoprotein-cholesterol (HDL-C) (r = -0.88, p = 0.000).

Increased cIMT was found to be associated with male gender, hypertriglyceridemia, hypercholesterolemia, high serum low density lipoprotein-cholesterol (LDL-C), low serum high density lipoprotein -cholesterol (HDL-C) as well as the presence of diabetic complications.

As cardiovascular morbidity is high in diabetes, non-invasive methods for monitoring vascular changes as cIMT might be useful in clinical practice for early diagnosis of subclinical atherosclerosis, which can allow for strategies designed to reduce the cardiovascular event rate in those patients.