Early Signs of Cardiovascular Disease in Youth With Obesity and Type 2 Diabetes
- Neslihan Gungor, MD1,
- Trina Thompson, RN, MPH, RVT2,
- Kim Sutton-Tyrrell, PHD2,
- Janine Janosky, PHD3 and
- Silva Arslanian, MD1
- 1Division of Pediatric Endocrinology Metabolism and Diabetes Mellitus, Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- 2Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- 3Division of Biostatistics, Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
- Address correspondence and reprint requests to Silva Arslanian, MD, Division of Endocrinology, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue at DeSoto Street, Pittsburgh, PA 15213. E-mail: silva.arslanian{at}chp.edu
- aPWV, aortic pulse wave velocity
- CVD, cardiovascular disease
- hs-CRP, high-sensitivity C-reactive protein
- IMT, intima media thickness
- HOMA-IS, homeostasis model assessment of insulin sensitivity
Atherosclerotic cardiovascular disease (CVD) is the major cause of mortality and morbidity in adults with type 2 diabetes (1). The origin of atherosclerosis is early in childhood with progression toward clinically significant lesions in young adulthood (2,3).
Carotid artery intima media thickness (IMT) and aortic pulse wave velocity (aPWV), a measure of arterial stiffness, are noninvasive measures of subclinical atherosclerosis that have been used as surrogate measures of cardiovascular events in various adult studies (4–9). Data regarding IMT and arterial stiffness in children are limited despite the increasing tide of obesity and type 2 diabetes. Therefore, in this pilot study, we aimed 1) to evaluate IMT and aPWV in obese adolescents with type 2 diabetes and 2) to investigate the relationship between these vascular markers and the clinical/metabolic risk factors of CVD.
RESEARCH DESIGN AND METHODS
We studied 20 adolescents with type 2 diabetes (undetectable islet-cell and GAD65 autoantibodies, duration 1.7 ± 0.4 years) and 22 normal-weight and 20 obese healthy control subjects. The groups were comparable for age, sex, ethnicity, and puberty assessed by Tanner criteria (10) (Table 1). Type 2 diabetic subjects were receiving either metformin or rosiglitazone (7), metformin with insulin (5), insulin alone (1), and metformin and acarbose (1) in addition to lifestyle modification. None of the subjects had a family history of hereditary hyperlipidemia. Four subjects were smokers (three normal weight and one obese) with no significant difference among the three groups for …
