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Hoffman RP, Copenhaver MM, Zhou D, Yu CY. Oral glucose tolerance response curve predicts disposition index but not other cardiometabolic risk factors in healthy adolescents. J Pediatr Endocrinol Metab 2021; 34:599-605. [PMID: 33818037 DOI: 10.1515/jpem-2020-0619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/10/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In obese adults the shape of the glucose response curve during an oral glucose tolerance test (OGTT) predicts future type 2 diabetes. Patients with an incessant increase or monophasic curves have increased risk compared to those with biphasic curves. Since type 2 diabetes is associated with increased cardiometabolic risk, we studied whether differences in OGTT response curve are associated with differences in cardiometabolic risk factors in healthy adolescents across a wide body mass index (BMI) range. METHODS Sixty-nine (33F/36M), white adolescents (age: 15.2 ± 1.7 years; BMI: 21.5 ± 4.7 kg/m2; mean ± SD) were studied. Risk factors measured included percent body fat, blood pressure, lipids, augmentation index, reactive hyperemia, endothelin 1, plasminogen activator 1, inflammatory markers (interleukin 6, c-reactive protein), insulin secretion, insulin sensitivity (Matusda index), and disposition index (DI). RESULTS Thirty-two subjects had biphasic responses; 35 subjects had monophasic responses and two females had incessant increases. Sex did not affect the frequency of responses. Glucose area under the curve during OGTT was greater in those with a mono vs. biphasic curves (p=0.01). Disposition index was markedly lower in subjects with a monophasic curve than in those with a biphasic curve (3.6 [2.3-5.0] vs. 5.8 [3.8-7.6], median [25th, 75th%] p=0.003). Triglyceride to high-density lipoprotein cholesterol (HDL) ratio was higher in subjects with a monophasic curve (p=0.046). CONCLUSIONS The decreased disposition index indicates that in healthy adolescents a monophasic response to OGTT is due to decreased insulin secretion relative to the degree of insulin resistance present. This was not associated with differences in most other cardiometabolic risk markers. TRIAL REGISTRATION Clinical Trials.gov, NCT02821104.
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Affiliation(s)
- Robert P Hoffman
- Division of Endocrinology, Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, USA
| | - Melanie M Copenhaver
- Division of Emergency Medicine, Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, USA
| | - Danlei Zhou
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, USA
| | - Chack-Yung Yu
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, USA
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Aziz M, Gannarapu S, Humayun C, Siddiqui U, Nasir K, Aneni EC. Association of particles of lipoprotein subclasses with arterial stiffness in a high-risk working population: the Baptist Employee Healthy Heart Study (BEHHS). Egypt Heart J 2020; 72:12. [PMID: 32193785 PMCID: PMC7082444 DOI: 10.1186/s43044-020-00046-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background Arterial stiffness is an independent predictor of cardiovascular disease (CVD) morbidity and mortality. A risk factor-independent association of arterial stiffness with traditional lipids has been described extensively, but it is still unclear whether an independent relationship exists between arterial stiffness and particles of lipoprotein subclasses. Methods The Baptist Employee Healthy Heart Study (BEHHS) is a lifestyle intervention study examining the effects of web-based programs on reducing CVD risk in high-risk persons. Participants had their brachial arterial augmentation index (AI, a measure arterial stiffness) assessed using the EndoPAT 2000 device. Cardio IQ™ ion mobility lipoprotein fractionation was utilized for measurement of particles of lipoprotein subclasses. Results The population consisted of 182 participants, (74% women, 49% Hispanic) with a mean age of 52 ± 9 years. There was a significant trend association between quartiles of AI and total cholesterol, HDL-c, large LDL-p, small IDL-p, large IDL-p, and all subclasses of HDL particles (total HDL-p, small HDL-p, and large HDL-p). In logistic regression analysis, only HDL-c, total LDL-p, large LDL-p, small IDL-p, large IDL-p, total HDL-p, small HDL-p, and large HDL-p demonstrated significant independent association with AI. Conclusion Several lipoprotein subclasses demonstrate independent significant associations with arterial stiffness. A safe and relatively inexpensive blood test may be useful in identifying subclinical atherosclerosis process in a relatively young high CVD risk population. Trial registration ClinicalTrials.gov, NCT01912209. Registered July 31, 2013
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Affiliation(s)
- Muhammad Aziz
- Family Medicine Center, West Kendall Baptist Hospital, Miami, FL, USA.,Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, 9555 SW 162nd Ave. MAB, Suite 103, Miami, FL, 33196, USA.,Florida International University, Department of Humanities, Health, and Society (HHS), Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Swetha Gannarapu
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, 9555 SW 162nd Ave. MAB, Suite 103, Miami, FL, 33196, USA
| | - Choudhry Humayun
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, 9555 SW 162nd Ave. MAB, Suite 103, Miami, FL, 33196, USA
| | - Usman Siddiqui
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, 9555 SW 162nd Ave. MAB, Suite 103, Miami, FL, 33196, USA
| | - Khurram Nasir
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, 9555 SW 162nd Ave. MAB, Suite 103, Miami, FL, 33196, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, 06510, USA.,Johns Hopkins University, Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA
| | - Ehimen C Aneni
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, 9555 SW 162nd Ave. MAB, Suite 103, Miami, FL, 33196, USA. .,Internal Medicine, Section of Cardiovascular Medicine, Yale-New Haven Hospital, New Haven, CT, 06510, USA.
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Llauradó G, Amigó N, Cano A, Ballesta S, Albert L, Mazarico I, Fernández-Veledo S, Pedro-Botet J, Vendrell J, González-Clemente JM. Specific Nuclear Magnetic Resonance Lipoprotein Subclass Profiles and Central Arterial Stiffness in Type 1 Diabetes Mellitus: A Case Control Study. J Clin Med 2019; 8:E1875. [PMID: 31694246 PMCID: PMC6912486 DOI: 10.3390/jcm8111875] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Dyslipidemia has been associated with vascular complications of type 1 diabetes mellitus (T1DM). We examined the proton nuclear magnetic resonance (NMR)-assessed lipoprotein subclass profiles in subjects with T1DM compared with those of healthy subjects and assessed the potential relationship of these profiles with arterial stiffness. METHODS Eighty-four participants with T1DM of at least 10 years duration and no clinical cardiovascular disease (age: 35-65 years; 50% men) and 42 healthy participants were evaluated for: (1) clinical and anthropometric data (including classical cardiovascular risk factors), (2) insulin sensitivity by estimated glucose disposal rate, (3) microvascular complications, (4) NMR-assessed lipoprotein subclass profile, and (5) arterial stiffness (aortic pulse wave velocity). RESULTS Participants with T1DM had an apparently better conventional lipid profile than healthy participants, but with significant differences in NMR-assessed lipoprotein profiles such as higher triglyceride content of low-density lipoprotein (LDL) and high-density lipoprotein (HDL). In healthy participants, arterial stiffness was associated with NMR-based LDL subclasses. By contrast, in T1DM participants, arterial stiffness was independently associated mainly with NMR-based very-low-density lipoprotein (VLDL) subclasses: positively with total VLDL particles (and subclasses) and VLDL triglyceride content, and negatively with LDL and HDL particle sizes. These results were maintained after adjustments for classical cardiovascular risk factors. CONCLUSIONS Subjects with T1DM, while having an apparently better conventional lipid profile than healthy controls, presented significant alterations in their NMR-assessed lipoprotein profile. The association between arterial stiffness and NMR-assessed lipoprotein profiles also differed in both groups. These results support a potential role of the identified differences in the residual cardiovascular risk in T1DM.
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Affiliation(s)
- Gemma Llauradó
- Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Pg. Marítim 25-29, 08003 Barcelona, Spain; (S.B.); (J.P.-B.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas; (CIBERDEM), Instituto de Salud Carlos III, 8029 Madrid, Spain; (S.F.-V.); (J.V.)
| | - Núria Amigó
- Metabolomics Platform IISPV, CIBERDEM. Universitat Rovira i Virgili, Bisofer Teslab Plaça del Prim 10, 43201 Reus, Spain;
| | - Albert Cano
- Department of Endocrinology and Nutrition. Hospital de Sabadell. Corporació Sanitària Parc Taulí. Institut d’Investigació i Innovació Parc Taulí (I3PT) (Universitat Autònoma de Barcelona), Parc Taulí s/n, 08208 Sabadell, Spain; (A.C.); (L.A.); (I.M.)
| | - Silvia Ballesta
- Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Pg. Marítim 25-29, 08003 Barcelona, Spain; (S.B.); (J.P.-B.)
| | - Lara Albert
- Department of Endocrinology and Nutrition. Hospital de Sabadell. Corporació Sanitària Parc Taulí. Institut d’Investigació i Innovació Parc Taulí (I3PT) (Universitat Autònoma de Barcelona), Parc Taulí s/n, 08208 Sabadell, Spain; (A.C.); (L.A.); (I.M.)
| | - Isabel Mazarico
- Department of Endocrinology and Nutrition. Hospital de Sabadell. Corporació Sanitària Parc Taulí. Institut d’Investigació i Innovació Parc Taulí (I3PT) (Universitat Autònoma de Barcelona), Parc Taulí s/n, 08208 Sabadell, Spain; (A.C.); (L.A.); (I.M.)
| | - Sonia Fernández-Veledo
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas; (CIBERDEM), Instituto de Salud Carlos III, 8029 Madrid, Spain; (S.F.-V.); (J.V.)
- Hospital Universitari Joan XXIII de Tarragona. Institut d’Investigacions Sanitàries Pere Virgili (IISPV). Universitat Rovira i Virgili, C. Dr. Mallafré Guasch 4, 43005 Tarragona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Pg. Marítim 25-29, 08003 Barcelona, Spain; (S.B.); (J.P.-B.)
| | - Joan Vendrell
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas; (CIBERDEM), Instituto de Salud Carlos III, 8029 Madrid, Spain; (S.F.-V.); (J.V.)
- Hospital Universitari Joan XXIII de Tarragona. Institut d’Investigacions Sanitàries Pere Virgili (IISPV). Universitat Rovira i Virgili, C. Dr. Mallafré Guasch 4, 43005 Tarragona, Spain
| | - José-Miguel González-Clemente
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas; (CIBERDEM), Instituto de Salud Carlos III, 8029 Madrid, Spain; (S.F.-V.); (J.V.)
- Department of Endocrinology and Nutrition. Hospital de Sabadell. Corporació Sanitària Parc Taulí. Institut d’Investigació i Innovació Parc Taulí (I3PT) (Universitat Autònoma de Barcelona), Parc Taulí s/n, 08208 Sabadell, Spain; (A.C.); (L.A.); (I.M.)
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Meehan CS, Kethireddy PL, Ashcraft JK, Shuster JJ, Haller MJ. Premeal insulin decreases arterial stiffness in children with type 1 diabetes. Pediatr Diabetes 2017; 18:311-314. [PMID: 27174580 PMCID: PMC6939859 DOI: 10.1111/pedi.12389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/22/2016] [Accepted: 03/22/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine the effects of omitting meal time insulin on arterial stiffness in children with type 1 diabetes. RESEARCH DESIGN AND METHODS In this prospective, randomized, crossover study, radial artery tonometry and augmentation index adjusted to heart rate 75 (AI75 ) were used to measure arterial stiffness. Children were randomized to receive or omit premeal insulin and completed the crossover portion of the study on a subsequent day. AI75 was determined when fasting, 1, and 2 h postmeal. RESULTS When comparing change in AI75 from baseline to 1 h and baseline to 2 h, when subjects received premeal insulin vs. no insulin, AI75 was 4.5 units lower at 1 h (p = 0.011, 95% CI:1.1 lower to 8 lower) and 4.3 units lower at 2 h (p = 0.062, 95% CI: 0.2 higher to 8.9 lower) (n = 40). CONCLUSIONS Arterial stiffness is decreased by premeal insulin in children with type 1 diabetes.
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Affiliation(s)
- Colette S. Meehan
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA
| | | | - Jordan K. Ashcraft
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA
| | - Jonathan J. Shuster
- Department of Health Outcomes and Policy Biostatistics Epidemiology and Research Design, Clinical Translational Science Institute, University of Florida, Gainesville, FL 32610, USA
| | - Michael J. Haller
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA
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Obermannova B, Petruzelkova L, Sulakova T, Sumnik Z. HbA1c but not diabetes duration predicts increased arterial stiffness in adolescents with poorly controlled type 1 diabetes. Pediatr Diabetes 2017; 18:304-310. [PMID: 27075550 DOI: 10.1111/pedi.12385] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The prevalence of macrovascular complications is probably underestimated in children with type 1 diabetes (T1D). Arterial stiffness (AS) is a subclinical marker of cardiovascular (CV) risk. The most validated, non-invasive method for AS measurement is pulse wave velocity (PWV). Only a few PWV studies have been performed in children with T1D. OBJECTIVE To explore the risk factors associated with AS in adolescents with suboptimally controlled T1D. PATIENTS AND METHODS Seventy-seven adolescents with T1D were included (39 girls, 38 boys) in this study. The adolescents had a median age of 16 yr (IQR 14-17), median duration of T1D was 9 yr (IQR 6-16), and HbA1c 71 mmol/mol (median, IQR 62-81). PWV was measured as the carotid-femoral pulse transmission time and converted into standard deviation scores (SDS) (adjusted for gender and age) using normative values for children. The risk factors assessed were HbA1c, T1D duration, treatment modality, serum lipids, and blood pressure (BP) measured via ambulatory blood pressure monitoring (ABPM). RESULTS The PWV did not differ from the reference data (median PWV was 5.1 m/s, i.e., -0.01 SDS). A significant positive association was observed between PWV-SDS and HbA1c (p = 0.001), total cholesterol (p = 0.003), LDL-cholesterol (p = 0.003), but not T1D duration (p = 0.78) according to the univariate analyses. In the multivariate model, the only significant variable that remained positively associated with PWV-SDS was HbA1c (p = 0.03). CONCLUSIONS Most adolescents with suboptimally controlled T1D have normal mean PWV compared to a healthy reference population. Chronic hyperglycemia, not T1D duration, is the main predictor of AS in adolescents.
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Affiliation(s)
- Barbora Obermannova
- Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Lenka Petruzelkova
- Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Terezie Sulakova
- Department of Pediatrics, University Hospital and Medical Faculty, University of Ostrava, Ostrava, Czech Republic
| | - Zdenek Sumnik
- Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Shah AS, Davidson WS, Gao Z, Dolan LM, Kimball TR, Urbina EM. Superiority of lipoprotein particle number to detect associations with arterial thickness and stiffness in obese youth with and without prediabetes. J Clin Lipidol 2016; 10:610-8. [PMID: 27206949 DOI: 10.1016/j.jacl.2016.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/07/2016] [Accepted: 01/26/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The nuclear magnetic resonance (NMR) lipoprotein profile provides additional cardiovascular risk information beyond traditional lipids in high-risk adults. Similar studies have not been conducted in youth. OBJECTIVE To evaluate the relationship between the NMR profile and preclinical vascular measures in youth. METHODS We studied 96 obese youth with prediabetes (mean age = 18.1 ± 3.6 years, 63% female, 78% African American) and 118 obese normoglycemic controls (mean age = 18.0 ± 3.1 years, 75% female, 62% African American) cross sectionally. Traditional lipids (triglycerides, total, high-density lipoprotein [HDL], and low-density lipoprotein [LDL] cholesterol), NMR particle size (particle concentration [P] and size) and vascular thickness (carotid IMT) and stiffness (pulse wave velocity [PWV]) were measured. Independent associations between lipoproteins with carotid IMT and PWV after adjustment for group, age, race, sex, BMI z score, blood pressure, HOMA-IR, and A1c were studied. RESULTS NMR analysis revealed youth with prediabetes exhibited a more atherogenic profile with higher levels of small LDL-P and HDL-P and lower levels of intermediate and large HDL-P (P < .03). In addition, lower intermediate HDL-P was associated with a higher carotid IMT, whereas higher small HDL-P was associated with a higher PWV (P < .01). Traditional lipids were not significantly different between groups and were not associated with either vascular outcome. CONCLUSIONS NMR lipoprotein subclasses have improved sensitivity compared to traditional lipids to detect lipoprotein abnormalities in normoglycemic and prediabetic obese youth and are independently associated with preclinical vascular thickness and stiffness. NMR lipids may enhance cardiovascular risk assessment in youth.
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Affiliation(s)
- Amy S Shah
- Division of Endocrinology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA.
| | - W Sean Davidson
- Center for Lipid and Arteriosclerosis Science, Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Zhiqian Gao
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Lawrence M Dolan
- Division of Endocrinology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Thomas R Kimball
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Elaine M Urbina
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
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Medina-Bravo P, Medina-Urrutia A, Juárez-Rojas JG, Cardoso-Saldaña G, Jorge-Galarza E, Posadas-Sánchez R, Coyote-Estrada N, Nishimura-Meguro E, Posadas-Romero C. Glycemic control and high-density lipoprotein characteristics in adolescents with type 1 diabetes. Pediatr Diabetes 2013; 14:399-406. [PMID: 23057424 DOI: 10.1111/j.1399-5448.2012.00924.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/03/2012] [Accepted: 08/02/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Recent evidence suggests that high-density lipoprotein (HDL) physicochemical characteristics and functional capacity may be more important that HDL-C levels in predicting coronary heart disease. There is little data regarding HDL subclasses distribution in youth with type 1 diabetes. OBJECTIVE To assess the relationships between glycemic control and HDL subclasses distribution, composition, and function in adolescents with type 1 diabetes. METHODS This cross-sectional study included 52 adolescents with type 1 diabetes aged 12-16 years and 43 age-matched non-diabetic controls. Patients were divided into two groups: one in fair control [hemoglobin A1c (HbA1c) < 9.6%] and the second group with poor glycemic control (HbA1c ≥ 9.6%). In all participants, we determined HDL subclasses distribution, composition, and the ability of plasma and of isolated HDL to promote cellular cholesterol efflux. Levels of soluble adhesion molecules were also measured. RESULTS Although both groups of patients and the control group had similar HDL-C levels, linear regression analyses showed that compared with non-diabetic subjects, the poor control group had a lower proportion of HDL2b subclass (p = 0.029), triglyceride enriched (p = 0.045), and cholesteryl ester depleted (p = 0.028) HDL particles. Despite these HDL changes, cholesterol efflux was comparable among the three groups. The poor control group also had significantly higher intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 plasma concentrations. CONCLUSIONS In adolescents with type 1 diabetes, poor glycemic control is associated with abnormalities in HDL subclasses distribution and HDL lipid composition, however, in spite of these HDL changes, the ability of HDL to promote cholesterol efflux remains comparable to that of healthy subjects.
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Affiliation(s)
- Patricia Medina-Bravo
- Department of Endocrinology, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico
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Cardiovascular disease risk in young people with type 1 diabetes. J Cardiovasc Transl Res 2012; 5:446-62. [PMID: 22528676 DOI: 10.1007/s12265-012-9363-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 03/20/2012] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease (CVD) is the most frequent cause of death in people with type 1 diabetes (T1D), despite modern advances in glycemic control and CVD risk factor modification. CVD risk identification is essential in this high-risk population, yet remains poorly understood. This review discusses the risk factors for CVD in young people with T1D, including hyperglycemia, traditional CVD risk factors (dyslipidemia, smoking, physical activity, hypertension), as well as novel risk factors such as insulin resistance, inflammation, and hypoglycemia. We present evidence that adverse changes in cardiovascular function, arterial compliance, and atherosclerosis are present even during adolescence in people with T1D, highlighting the need for earlier intervention. The methods for investigating cardiovascular risk are discussed and reviewed. Finally, we discuss the observational studies and clinical trials which have thus far attempted to elucidate the best targets for early intervention in order to reduce the burden of CVD in people with T1D.
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Abstract
Type 1 diabetes mellitus (T1D) is associated with an increased risk of cardiovascular disease (CVD) that begins in childhood. Youth with T1D develop concerning functional cardiac and vascular defects and evidence of early atherosclerosis, despite modern advancements in risk reduction and glycemic management. Such early defects predict poor long-term outcomes. Women with T1D also have higher CVD risk than expected for unexplained reasons. Insulin resistance (IR) is recently recognized as a prominent factor in T1D youth and adults, but with an atypical clinical phenotype. This IR may contribute to early cardiac and vascular dysfunction and long-term CVD in T1D. A better understanding of potential contributors to cardiovascular dysfunction in T1D youth such as IR and its unique phenotype in T1D, subtle lipid abnormalities, and gender differences is now required to address the current knowledge gaps and to prevent cardiovascular morbidity and mortality in T1D.
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Affiliation(s)
- Kristen J Nadeau
- Pediatric Endocrinology, University of Colorado/The Children's Hospital, 13123 East 16th Avenue, B265, Aurora, CO 80045, USA.
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