Endothelial dysfunction and increased arterial intima-media thickness in children with type 1 diabetes.
BACKGROUND
Endothelial dysfunction may play a pathophysiological role in the development of atherosclerosis in subjects with type 1 diabetes. We examined whether alterations in vascular endothelial function exist in children with type 1 diabetes and tested the hypothesis that endothelial dysfunction is associated with early structural atherosclerotic vascular changes in these children.


RESULTS
Noninvasive ultrasound was used to measure brachial artery flow-mediated dilation (FMD) responses and carotid artery intima-media thickness (IMT) in 75 children (mean age 11+/-2 years), 45 with type 1 diabetes (diabetes duration 4.4+/-2.9 years) and 30 healthy control children. Children with diabetes had lower peak FMD response (4.4+/-3.4% versus 8.7+/-3.6%, P<0.001) and increased IMT (P<0.001) compared with controls. Sixteen children with diabetes (36%) had endothelial dysfunction defined as total FMD response in the lowest decile for normal children. These children had increased carotid IMT (0.58+/-0.05 versus 0.54+/-0.04 mm, P=0.01) and higher LDL cholesterol concentration (2.63+/-0.76 versus 2.16+/-0.60 mmol/L, P=0.03) compared with diabetic children without endothelial dysfunction. Multivariate correlates of increased IMT included diabetes group (P=0.03), low FMD (P=0.03), and high LDL cholesterol (P=0.08).


CONCLUSIONS
Impaired FMD response is a common manifestation in children with type 1 diabetes and is associated with increased carotid artery IMT. These data suggest that endothelial dysfunction in children with type 1 diabetes may predispose them to the development of early atherosclerosis.
Järvisalo
Mikko J
MJ
Department of Clinical Physiology, University of Turku, Turku, Finland. mikko.jarvisalo@utu.fi
Raitakari
Maria
M
Toikka
Jyri O
JO
Putto-Laurila
Anne
A
Rontu
Riikka
R
Laine
Seppo
S
Lehtimäki
Terho
T
Rönnemaa
Tapani
T
Viikari
Jorma
J
Raitakari
Olli T
OT
D000293:Adolescent; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D002340:Carotid Artery Diseases / Q000209:etiology / Q000473:pathology*; D002648:Child; D008078:Cholesterol, LDL / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D004198:Disease Susceptibility; D004730:Endothelium, Vascular / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D017127:Glycation End Products, Advanced; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D017539:Tunica Intima / Q000648:ultrastructure*; D017540:Tunica Media / Q000648:ultrastructure*; D014463:Ultrasonography; D014664:Vasodilation; D000093844:Glycated Proteins
D008078:Cholesterol, LDL; D017127:Glycation End Products, Advanced; D008077:Lipoproteins, LDL; C031797:glycated lipoproteins, LDL; D000093844:Glycated Proteins; C099252:oxidized low density lipoprotein