Cardiovascular Risk Factors Are Associated With Increased Arterial Stiffness in Youth With Type 1 Diabetes
The SEARCH CVD study
- Dana Dabelea, MD, PHD1⇑,
- Jennifer W. Talton, MS2,
- Ralph D’Agostino Jr., PHD2,
- R. Paul Wadwa, MD3,4,
- Elaine M. Urbina, MD, PHD5,
- Lawrence M. Dolan, MD5,
- Stephen R. Daniels, MD, PHD4,
- Santica M. Marcovina, PHD6 and
- Richard F. Hamman, MD, DRPH1
- 1Colorado School of Public Health, Aurora, Colorado
- 2Wake Forest School of Medicine, Winston-Salem, North Carolina
- 3Barbara Davis Center for Childhood Diabetes, Aurora, Colorado
- 4Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- 5Cincinnati Children’s Hospital, Cincinnati, Ohio
- 6Northwest Lipids Laboratories, University of Washington, Seattle, Washington
- Corresponding author: Dana Dabelea, .
OBJECTIVE To evaluate if presence of cardiovascular (CV) risk factors and their clustering as metabolic syndrome (MetS) is associated with increased arterial stiffness and accelerated progression over time among youth with type 1 diabetes.
RESEARCH DESIGN AND METHODS Longitudinal study of 298 youth with type 1 diabetes (age 14.5 years; 46.3% female; duration 4.8 years), with two research visits conducted 5 years apart. CV factors included: waist circumference, blood pressure (BP), fasting lipids (HDL cholesterol, LDL cholesterol [LDL-c], triglycerides), albumin/creatinine ratio, and HbA1c. MetS was based on Adult Treatment Panel III criteria modified for youth. Pulse wave velocity (PWV) in the carotid–femoral segment was measured by tonometry. Mixed models were used to assess the rate of progression in PWV and the association between CV factors and PWV over time.
RESULTS PWV increased significantly over time (0.145 m/s/year; P < 0.0001). MetS (P = 0.0035), large waist (P < 0.0001), and elevated BP (P = 0.0003) at baseline were each associated with worse PWV over time. These baseline factors, however, did not significantly influence the rate of progression. Increases in waist circumference (P < 0.0001), LDL-c levels (P = 0.0156), and declining glucose control (HbA1c; P = 0.0419) were independently associated with higher PWV over time.
CONCLUSIONS Presence, clustering, and worsening of CV risk factors are associated with increased arterial stiffness over time in youth with type 1 diabetes. Whether improvement in CV risk factors early in life will slow the progression of arterial stiffness and reduce the burden of CV disease in this population requires further study.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc13-0851/-/DC1.
- Received April 10, 2013.
- Accepted July 3, 2013.
- © 2013 by the American Diabetes Association.
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