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J Am Heart Assoc. 2019 Jul 2;8(13):e010150. doi: 10.1161/JAHA.118.010150. Epub 2019 Jun 19.

Burden of Cardiovascular Risk Factors Over Time and Arterial Stiffness in Youth With Type 1 Diabetes Mellitus: The SEARCH for Diabetes in Youth Study.

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1 Heart Institute Cincinnati Children's Hospital & University of Cincinnati OH.
3 Department of Biostatistical Sciences Wake Forest School of Medicine Winston-Salem NC.
4 Department of Public Health East Carolina University Greenville NC.
5 Division of Pediatric Endocrinology & Diabetes Medical University of South Carolina Charleston SC USA.
6 Department of Pediatrics University of Colorado School of Medicine Aurora CO.
2 Department of Endocrinology Cincinnati Children's Hospital & University of Cincinnati OH.
8 Division of Diabetes Translation Centers for Disease Control and Prevention Atlanta GA.
9 Northwest Lipid Metabolism and Diabetes Research Laboratory University of Washington Seattle WA.
10 Department of Epidemiology and Biostatistics University of South Carolina Columbia SC USA.
11 Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA.
7 Barbara Davis Center for Childhood Diabetes University of Colorado School of Medicine Aurora CO.
12 Department of Epidemiology Colorado School of Public Health Aurora CO.


Background The incidence of type 1 diabetes mellitus (T1DM) in children is increasing, resulting in higher burden of cardiovascular diseases due to diabetes mellitus-related vascular dysfunction. Methods and Results We examined cardiovascular risk factors ( CVRF s) and arterial parameters in 1809 youth with T1DM. Demographics, anthropometrics, blood pressure, and laboratory data were collected at T1DM onset and 5 years later. Pulse wave velocity and augmentation index were collected with tonometry. ANOVA or chi-square tests were used to test for differences in measures of arterial parameters by CVRF . Area under the curve of CVRF s was entered in general linear models to explore determinants of accelerate vascular aging. Participants at the time of arterial measurement were 17.6±4.5 years old, 50% female, 76% non-Hispanic white, and duration of T1DM was 7.8±1.9 years. Glycemic control was poor (glycated hemoglobin, 9.1±1.8%). All arterial parameters were higher in participants with glycated hemoglobin ≥9% and pulse wave velocity was higher with lower insulin sensitivity or longer duration of diabetes mellitus. Differences in arterial parameters were found by sex, age, and presence of obesity, hypertension, or dyslipidemia. In multivariable models, higher glycated hemoglobin, lower insulin sensitivity, body mass index, blood pressure, and lipid areas under the curve were associated with accelerated vascular aging. Conclusions In young people with T1DM, persistent poor glycemic control and higher levels of traditional CVRF s are independently associated with arterial aging. Improving glycemic control and interventions to lower CVRF s may prevent future cardiovascular events in young individuals with T1DM.


arterial compliance; diabetes mellitus; pediatric; risk factor

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