Relation between Lipids, Apolipoproteins, Vitamin D levels and Carotid Artery Intima-Media Thickness in Adolescents with Type 1 Diabetes

Abstract

Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action or both. Morbidity and mortality in type 1 diabetic patients derive mainly from advanced microvascular, and macrovascular complications.

Adolescents with type 1 diabetes are at increased risk of early asymptomatic atherosclerosis, and cardiovascular morbidity and mortality. Progression of CVD in youth with type 1 diabetes can be more aggressive than in adults with diabetes, therefore highlighting the importance of early preventive strategies. Studies in children without diabetes demonstrate that the atherosclerotic process begins early in life and that high lipid levels during childhood are associated with coronary atherosclerosis in adulthood. There is also evidence that the atherosclerotic process begins earlier in children and youth with type 1 diabetes.

Carotid arteriopathy has been reported in paediatric patients with diabetes. Abnormalities of the carotid artery have been accepted as markers of the early, asymptomatic phase of the atherosclerotic process in adults. The early stages of atherosclerosis are associated with changes in arterial structure. Subtle stru¬ctural changes such as thickening of arterial intima-media complex thickness (IMT) occur early in the atherosclerotic disease process.

Carotid intima media thickness (cIMT) is now used commonly as a non-invasive test for assessment of degree of atherosclerosis. Increased cIMT has been reported in children with type 1 diabetes. Given that cIMT has been identified as a surrogate marker for increased cardiovascular risk, it is important to determine which factors, contribute to the increased cIMT in T1DM adolescents. cIMT has been correlated to cardiac risk factors and established as a cardiac screening tool in studies on high risk adults. The risk factors predicting cIMT are not well established in pediatric diabetic patients. The current study aim was to explore the risk factors predisposing to increased cIMT, and so early atherosclerosis in children and adolescents with type 1 diabetes.

Emerging evidences indicate that vitamin D deficiency, cardiovascular disease, and endothelial dysfunction are linked by biological associations. In addition, vitamin D deficiency is significantly associated with increased risk of cardiovascular adverse events.