Altered cardiovascular risk markers, cardiac structure and cardiac function in adolescents with type 1 diabetes

Childhood onset type 1 diabetes (T1D) is associated with vascular and cardiac complications. Clinical disease typically manifests in adulthood.Aim: To assess blood, ultrasound (US) and Doppler echocardiographic cardiovascular risk markers in adolescents with T1D (≥5 years duration) compared to controls.Methods: Design Case control study. Setting Tertiary paediatric hospital clinic. Population 27 (14F/13M) adolescents with T1D (age (median, interquartile range) 15.5, 14.7-16.4 years; duration 7.7; 6.0-11.8 years; HbA1c 9.1, 8.1-10.1%) and 27 (14F/13M) control participants (age 15.1, 14.4-16.8 years). BMI was <95th percentile. Measures Anthropometry and blood pressure were measured. Fasting blood samples were analysed for lipids, adipocytokines (leptin, resistin, adiponectin) and markers of inflammation (high-sensitivity C-reactive protein (CRP), interleukin (IL)-1β, IL-6, IL-10, tumour necrosis factor-α, complement component C5a, IL-1 receptor antagonist (Ra)), oxidative stress (isoprostanes, total antioxidant capacity, superoxide dismutase), free radical formation (advanced glycation endproducts, 3-nitrotyrosine) and endothelial / thrombotic function (inter cellular adhesion molecule-1 (ICAM-1), vascular-CAM-1, platelet endothelial CAM-1, Pentraxin3, sE-Selectin, von Willebrand Factor (vWF), platelet factor-4, plasminogen activator inhibitor-1). Carotid intima-media thickness was measured by US and cardiac structure and function by Echo-Doppler. Univariate comparisons Spearman correlations and t-tests / Wilcoxon rank sum tests. Principal components analysis (PCA) separately for blood and US / Echo-Doppler measures to derive composite scores (PCs), and logistic regression. Reporting Odd Ratio (OR) with 95% confidence interval.Results: In the univariate analyses, hsCRP, IL-1Ra, ICAM-1,isoprostanes, sE-Selectin and vWF were increased in the T1D group. The final logistic regression model initially containing gender, BMI z-score, IL-1Ra, vWF and 7 derived PCs, indicated that, adjusted for gender (p=0.03), higher BMI z-score (OR 5.52, 1.78-17.12, p=0.003) and lower PC score weighted on some of the cardiac indices (Left atrial (LA) area, LA volume index, Left ventricular (LV) volume index, LV mass index, LV end diastolic diameter and early (E) / late (A) LV diastolic filling) (OR 0.17, 0.05-0.60, p=0.006) were associated with T1D.Conclusion: Differences in blood cardiovascular risk markers, cardiac structure and cardiac function were detected in adolescents with T1D.