Major Finding: Decreased BrachD, a measure of peripheral vascular stiffness, was the most common abnormality in the type 1 diabetes group, found in 33.1%.
Data Source: A study of 535 adolescents with type 1 diabetes, who are part of the SEARCH study, and 241 healthy controls.
Disclosures: The SEARCH study is funded by the Centers for Disease Control and Prevention and supported by the National Institute of Diabetes and Digestive and Kidney Diseases. The authors declared no conflicts of interest.
Abnormal vascular stiffness, a marker of early vascular disease, is found in adolescents with type 1 diabetes at a rate of about 32% in boys and 6% in girls, according to an analysis of data from the SEARCH for Diabetes in Youth Study.
Type 1 diabetes was an independent predictor of all measures of vascular stiffness, even after adjustment for cardiovascular risk factors, said Dr. Elaine M. Urbina of Cincinnati Children's Hospital Medical Center and her colleagues (J. Pediatr. 2010;156:731–7).
“Patients with [type 1 diabetes], even at a young age, are at an increased risk for vascular stiffness and endothelial function by nature of their disease,” Dr. Janet H. Silverstein, a pediatric endocrinologist at the University of Florida, Gainesville, wrote in an accompanying editorial. “Modifiable risk factors should be monitored and, if they are abnormal, aggressive treatment undertaken.”
The study involved 535 adolescents with type 1 who were part of the larger SEARCH study group; their average age was 14.6 years and 13% were “nonwhite.” The 241 healthy control subjects (average age 17.8 years, 58% “nonwhite”) were selected from an ongoing study of vascular function in adolescents.
Height, weight, body mass index, and waist circumference were recorded for all subjects, as were glycated hemoglobin A1c, fasting glucose, triglycerides, and total, LDL, and HDL cholesterol.
Vascular function testing included measurement of systolic, diastolic, and mean arterial blood pressure, pulse, heart rate, and brachial artery distensibility (BrachD).
Arterial stiffness was assessed by measurement of pulse wave velocity for the trunk, arm, and leg, plus augmentation index, adjusted to a standard heart rate of 75 beats per minute (AIx-75).
As expected, the study noted higher BP and heart rates, HbA1c, fasting glucose, and total and LDL cholesterol, and lower HDL cholesterol in the type 1 subjects.
Greater arterial stiffness in the type 1 group was shown in lower BrachD, higher AIx-75, and higher age-adjusted pulse wave velocity trunk measurements.
Decreased BrachD, a measure of peripheral vascular stiffness, was the most common abnormality, in 33.1% of the type 1 patients. Peripheral stiffness correlates with left ventricular hypertrophy and is associated with peripheral artery disease and vessel calcification, the investigators noted. “The independent correlates of vascular dysfunction in this cohort of youth with [type 1 diabetes] included modifiable (higher BP, greater adiposity, and more atherogenic lipid profile) and nonmodifiable CV risk factors (older age, nonwhite race/ethnicity and male sex).”