European Journal of Pediatrics

, Volume 171, Issue 8, pp 1193–1202 | Cite as

Prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes in Austria

  • Claudia Steigleder-Schweiger
  • Birgit Rami-Merhar
  • Thomas Waldhör
  • Elke Fröhlich-Reiterer
  • Ines Schwarz
  • Maria Fritsch
  • Martin Borkenstein
  • Edith Schober
Original Article


Mortality of cardiovascular diseases in patients with type 1 diabetes is increased 2- to 20-fold compared to non-diabetic individuals. In young adults with type 1 diabetes, cardiovascular events are more often the cause of premature death than nephropathy. The aim of this study was to evaluate the prevalence and extent of cardiovascular risk factors in children and adolescents with type 1 diabetes in Austria. In a cross sectional study data of children with type 1 diabetes <18 years of age treated at the Children’s department of the University Hospitals of Vienna and Graz were collected. We recorded body mass index, waist circumference, blood pressure, HbA1c, triglycerides, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol according to age, sex, age at manifestation, diabetes duration, and insulin requirement. From 264 patients (49.4% male) complete data were available. Of all patients, 76.1% had one or more risk factors, 20.8% had two or more, 10.2% had three or more, and 4.9% had four or more risk factors. Insufficient glycemic control was the most frequent risk factor, present in 60.6% of our patients, followed by elevated triglycerides (22.7%) and increased body mass index (20.1%). Higher prevalence of risk factors was correlated with increasing age, diabetes duration, HbA1c, and insulin requirement. In conclusion, children and adolescents with type 1 diabetes have a much higher prevalence of cardiovascular risk factors compared to non-diabetic individuals. To prevent future cardiovascular events, achieving the best possible glycemic control, early detection of further risk factors, and adequate intervention are highly important.


Type 1 diabetes Cardiovascular risk factors Children and adolescents HbA1c Quality of metabolic control 



body mass index


blood pressure


cystic fibrosis related diabetes


cardiovascular disease


cardiovascular risk factor


diastolic blood pressure


high-density-lipoprotein cholesterol


low-density-lipoprotein cholesterol


systolic blood pressure


type 1 diabetes mellitus


type 2 diabetes mellitus


total cholesterol




waist circumference


Conflicts of interest

The authors declare that there is no duality of interest associated with this manuscript.


  1. 1.
    American Academy of Pediatrics (1992) I. Rationale for attention to cholesterol levels in children and adolescents. Pediatr 89(3):528–536Google Scholar
  2. 2.
    Black DM (2001) Statins in children: what do we know and what do we need to know? Curr Atheroscler Rep 3(1):29–34PubMedCrossRefGoogle Scholar
  3. 3.
    Bonetti PO, Lerman LO, Napoli C, Lerman A (2003) Statin effects beyond lipid lowering: are they clinically relevant? Eur Heart J 24(3):225–248PubMedCrossRefGoogle Scholar
  4. 4.
    Caprio S (2005) Definition and pathophysiology of the metabolic syndrome in obese children and adolescents. Int J Obes 29:S24–S25CrossRefGoogle Scholar
  5. 5.
    Centers for Disease Control and Prevention (2000) Clinical growth charts 5th–95th percentile for children 2 to 20 years (boys stature-for-age, girls stature-for-age)
  6. 6.
    Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH (2003) Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med 157:821–827PubMedCrossRefGoogle Scholar
  7. 7.
    Diabetes Control and Complication Trial (DCCT) Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986CrossRefGoogle Scholar
  8. 8.
    Diabetes Control and Complications Trial / Epidemiology of Diabetes Interventios and Complications (DCCT/EDIC) Research Group (2003) Intensive diabetes therapy and carotid intima-media thickness in type 1 diabetes mellitus. N Engl J Med 348:2294–2303CrossRefGoogle Scholar
  9. 9.
    Diabetes Control and Complications Trial / Epidemiology of Diabetes Interventios and Complications (DCCT/EDIC) Research Group (2005) Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 353:2643–2653CrossRefGoogle Scholar
  10. 10.
    Diabetes Control and Complications Trial /Epidemiology of Diabetes Interventios and Complications (DCCT/EDIC) Research Group (2001) Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the diabetes control and complication trial. J Pediatr 139:804–812CrossRefGoogle Scholar
  11. 11.
    Donaghue KC, Chiarelli F, Trotta D, Allgrove J, Dahl-Jogensen K (2009) Microvascular and macrovascular complications associated with diabetes in children and adolescents: ISPAD Clinical Practice Consensus Guidelines 2009 Compendium. Pediatr Diabetes 10(S12):195–203PubMedCrossRefGoogle Scholar
  12. 12.
    Edge JA, James T, Shine B (2008) Longitudinal screening of serum lipids in children and adolescents with Type 1 diabetes in a UK clinic population. Diabet Med 25:942–48PubMedCrossRefGoogle Scholar
  13. 13.
    Fernández JR, Redden DT, Pietrobelli A, Allison DB (2004) Waist circumference percentiles in nationally representative samples of African–American, European–American, and Mexican–American children and adolescents. J Pediatr 145(4):439–444PubMedCrossRefGoogle Scholar
  14. 14.
    Gerstein HC, Anand S, Yi QL, Vuksan V, Lonn E, Toe K, Malmberg K, McQueen M, Yusuf S, for the SHARE investigators (2003) The relationship between dysglycemia and atherosclerosis in South Asian, Chinese and European individuals in Canada. Diabetes Care 26:144–149PubMedCrossRefGoogle Scholar
  15. 15.
    Goodman E (2006) Pediatric metabolic syndrome: smoke and mirrors or true magic? Editorials. J Pediatr 148(2):149–151PubMedCrossRefGoogle Scholar
  16. 16.
    Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß HC, Hesse V, von Hippel A, Jaeger U, Johnsen D, Korte W, Menner K, Müller G, Müller JM, Niemann-Pilatus A, Remer T, Schaefer F, Wittchen HU, Zabransky S, Zellner K, Ziegler A, Hebebrand J (2001) Perzentile für den Body-Mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilkunde 149:807–818CrossRefGoogle Scholar
  17. 17.
    Larsen J, Brekke M, Sandvik L, Arnesen H, Hanssen KF, Dahl-Jorgensen K (2002) Silent coronary atheromatosis in type 1 diabetic patients and its relation to long-term glycemic control. Diabetes 51:2637–2641PubMedCrossRefGoogle Scholar
  18. 18.
    Margeirsdottir HD, Larsen JR, Brunbog C, Overby NC, Dahl-Jorgensen K, The Norwegian Study Group for Childhood Diabetes et al (2008) High prevalence of cardiovascular risk factors in children and adolescents wth type I diabetes: a population based study. Diabetologia 51(4):554–561. doi: 10.1007/s00125-007-0921-8 PubMedCrossRefGoogle Scholar
  19. 19.
    McCrindle BW, Ose L, Marais D (2003) Efficacy and safety of atorvastatin in children and adolescents with familial hypercholesterolemia or severe hyperlipidemia. J Pediatr 142:74–80Google Scholar
  20. 20.
    Morrison JA, Glueck CJ, Horn PS, Yeramaneni S, Wang P (2009) Pediatric triglycerides predict cardiovascular disease events in the fourth to fifth decade of life. Metabolism 58:1277–84PubMedCrossRefGoogle Scholar
  21. 21.
    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatr 114:555–576CrossRefGoogle Scholar
  22. 22.
    Neuhauser M, Thamm M (2007) Blood pressure measurements in the German health interview and examination survey for children and adolescents (KiGGS). Methodology and initial results. Bundesgesundheitsbl, Gesundheitsforsch. Gesundheitsschutz 50:728–735CrossRefGoogle Scholar
  23. 23.
    Reinehr T, Holl RW, Roth CL, Wiesel T, Stachow R, Wabitsch, Andler W, The DPV-Wiss Study Group (2006) Insulin resistance in children and adolescents with type I diabetes mellitus: relation to obesity. Pediatr Diabetes 6:5–12CrossRefGoogle Scholar
  24. 24.
    Rewers M, Pihoker C, Donaghue K, Hanas R, Swift P, Klingensmith GJ (2007) Assessment and monitoring of glycemic control in children and adolescents with diabetes (ISPAD Clinical Practice Consensus Guidelines 2006–2007). Pediatr Diabetes 8:408–418PubMedCrossRefGoogle Scholar
  25. 25.
    Schwab KO, Doerfer J, Hecker W, Grulich-Henn J, Wiemann D, Kordonouri O, Beyer P, Holl RW, The DPV Initiative of the German Working Group for Pediatric Diabetology (2006) Spectrum and prevalence of atherogenetic risk factors in 27358 children, adolescents and young adults with type I diabetes. Diabetes Care 29:218–225PubMedCrossRefGoogle Scholar
  26. 26.
    Snell-Bergeon JK, Hokanson JE, Jensen L, MacKEnzie T, Kinney G, Dabelea D, Eckel RH, Ehrlich J, Garg S, Rewers M (2003) Progression of coronary artery calcification in type 1 diabetes: the importance of glycemic control. Diabetes Care 26:2923–2928PubMedCrossRefGoogle Scholar
  27. 27.
    Soedamah-Muthu SS, Chaturvedi N, Toeller M, Ferriss B, Reboldi P, Michel G, Manes C, Fuller JH, The EURODIAB Prospective Complication Study Group (2004) Risk factors for coronary heart disease in type I diabetes patients in Europe. Diabetes Care 27(2):530–537PubMedCrossRefGoogle Scholar
  28. 28.
    Thorn LM, Forsblom C, Fagerudd J, Thomas MC, Pettersson-Fernholm K, Saraheimo M, Waden J, Rönnback M, Rosengard-Bärlund M, Björkestein CG, Taskinen MR, Groop PH, on behalf of the FINN-DIANE Study Group (2005) Metabolic Syndrome in type I diabetes. Diabetes Care 28(8):2019–2024PubMedCrossRefGoogle Scholar
  29. 29.
    Urbina EM, Wadwa P, Davis C, Snively BM, Dolan LM, Daniels SR, Hamman RF, Dabelea D (2010) Prevalence of increased arterial stiffness in children with type 1 diabetes mellitus differs by measurement site and sex: The search for diabetes in youth study. J Pediatr 156:731–737PubMedCrossRefGoogle Scholar
  30. 30.
    Van Vliet M, Van der Heyden JC, Diamant M, Von Rosenstiel IA, Schindhelm RK, Aanstoot HJ, Veeze HJ (2010) Overweight is highly prevalent in children with type 1 diabetes and associates with cardiometabolic risk. J Pediatr 156(6):923–929PubMedCrossRefGoogle Scholar
  31. 31.
    World Health Organisation (WHO) (1999) Definition, diagnosis and classification of diabetes mellitus and its complications. WHO, GenevaGoogle Scholar
  32. 32.
    Zimmet P, Alberti KGMM, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S, IDF Consensus Group (2007) The metabolic syndrome in children and adolescents—an IDF consensus report. Pediatr Diabetes 8(5):299–306. doi: 10.1111/j.1399-5448.2007.00271.x PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Claudia Steigleder-Schweiger
    • 1
  • Birgit Rami-Merhar
    • 2
  • Thomas Waldhör
    • 3
  • Elke Fröhlich-Reiterer
    • 4
  • Ines Schwarz
    • 4
  • Maria Fritsch
    • 2
  • Martin Borkenstein
    • 4
  • Edith Schober
    • 2
  1. 1.Department of Pediatrics, University Hospital of SalzburgParacelsus Medical UniversitySalzburgAustria
  2. 2.Department of PediatricsMedical University of ViennaViennaAustria
  3. 3.Department of Epidemiology, Center of Public HealthMedical University of ViennaViennaAustria
  4. 4.Department of PediatricsMedical University of GrazViennaAustria

Personalised recommendations