European Journal of Pediatrics

, Volume 166, Issue 6, pp 541–548

Early atherosclerosis in childhood type 1 diabetes: role of raised systolic blood pressure in the absence of dyslipidaemia

  • Karl Otfried Schwab
  • Jürgen Doerfer
  • Andreas Krebs
  • Kristin Krebs
  • Elisabeth Schorb
  • Kristiane Hallermann
  • Andrea Superti-Furga
  • Barbara Zieger
  • Winfried März
  • Arno Schmidt-Trucksäss
  • Karl Winkler
Oribinal Paper

DOI: 10.1007/s00431-007-0440-0

Cite this article as:
Schwab, K.O., Doerfer, J., Krebs, A. et al. Eur J Pediatr (2007) 166: 541. doi:10.1007/s00431-007-0440-0

Abstract

The intentions of our investigation were (1) to search for atherogenic risk factors and signs of incipient atherosclerosis in children and adolescents with type 1 diabetes (T1DM) in comparison to well-matched control subjects, (2) to evaluate risk factor associations with carotid intima media thickness (cIMT) in diabetic patients and control subjects, and (3) to acquire a better knowledge of early atherogenesis in children and adolescents with and without T1DM. 94 diabetic children (age median 12.3 years, HbA1c median 7.7%) and 40 non-diabetic controls (age median 12.3 years) were investigated. Mean cIMT was determined using high-resolution B-mode ultrasound with an automated contour identification procedure. Compared to controls, subjects with diabetes had significantly elevated cIMT (p = 0.041) and systolic BP (p = 0.007) but showed a less atherogenic lipid profile. Most markers of inflammation, endothelial function and fibrinolytic activity were higher in diabetic subjects than in controls. Multiple linear regression analysis revealed a significant relationship (r = 0.53, p = 0.036) between bilateral mean cIMT and diverse risk factors in patients with T1DM. Spearman rank correlation showed that diabetes duration (rho = 0.32, p = 0.029), systolic BP (rho = 0.32, p = 0.004), weight (rho = 0.257, p = 0.022), and height (rho = 0.265, p = 0.018) significantly correlated with bilateral mean cIMT in the 94 diabetic patients. In conclusion, in well-controlled type 1 diabetic children systolic BP may be of greater importance than dyslipidaemia in early atherogenesis. BMI, markers of sustained inflammation, endothelial dysfunction and fibrinolytic activity are increased in diabetic versus non-diabetic children but none of them correlates significantly with cIMT. Their prognostic value remains to be determined.

Keywords

Intima-media thickness Childhood type 1 diabetes Blood pressure Lipids Markers of inflammation 

Abbreviations

T1DM

type 1 diabetes mellitus

BMI-SDS

body mass index-standard deviation score

BP

blood pressure

cIMT

carotid intima-media thickness

CCA

common carotid artery

CHD

coronary heart disease

TC

total cholesterol

TG

triglycerides

apo B

apolipoprotein B

hs-CRP

high sensitive C-reactive protein

vWf

von Willebrand factor antigen

PAP

plasmin/α2-antiplasmin complex

PAI

plasminogen activator inhibitor

ICAM

intracellular adhesion molecule

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Karl Otfried Schwab
    • 1
  • Jürgen Doerfer
    • 1
  • Andreas Krebs
    • 1
  • Kristin Krebs
    • 2
  • Elisabeth Schorb
    • 1
  • Kristiane Hallermann
    • 1
  • Andrea Superti-Furga
    • 1
  • Barbara Zieger
    • 1
  • Winfried März
    • 2
  • Arno Schmidt-Trucksäss
    • 3
  • Karl Winkler
    • 2
  1. 1.Department of Pediatrics and Adolescents MedicineUniversity HospitalFreiburgGermany
  2. 2.Department of Clinical ChemistryUniversity HospitalFreiburgGermany
  3. 3.Department of Preventative and Rehabilitative Sports MedicineTechnical UniversityMunichGermany

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