title: Early atherosclerosis relates to urinary albumin excretion and cardiovascular risk factors in adolescents with type 1 diabetes: Adolescent type 1 Diabetes cardio-renal Intervention Trial (AdDIT).
abstract: OBJECTIVE
  The origins of cardiovascular and renal disease in type 1 diabetes begin during childhood. We aimed to evaluate carotid (cIMT) and aortic intima-media thickness (aIMT) and their relationship with cardiovascular risk factors and urinary albumin excretion in adolescents with type 1 diabetes in the Adolescent Type 1 Diabetes cardio-renal Intervention Trial (AdDIT).
  
  
  METHODS
  A total of 406 adolescents with type 1 diabetes, who were 14.1 ± 1.9 years old with type 1 diabetes duration of 6.7 ± 3.7 years, and 57 age-matched control subjects provided clinical and biochemical data and ultrasound measurements of vascular structure (cIMT and aIMT). Vascular endothelial and smooth muscle function was also measured in 123 of 406 with type 1 diabetes and all control subjects.
  
  
  RESULTS
  In type 1 diabetic subjects, mean/maximal aIMT (P < 0.006; <0.008), but not mean/maximal cIMT, was greater than in control subjects. Mean/maximal aIMT related to urinary albumin-to-creatinine ratio (multiple regression coefficient [SE], 0.013 [0.006], P = 0.03; 0.023 [0.007], P = 0.002), LDL cholesterol (0.019 [0.008], P = 0.02; 0.025 [0.011], P = 0.02), and age (0.010 [0.004], P = 0.004; 0.012 [0.005], P = 0.01), independent of other variables. Mean/maximal cIMT was greater in males (0.023 [0.006], P = 0.02; 0.029 [0.007], P < 0.0001), and mean cIMT related independently to systolic blood pressure (0.001 [0.001], P = 0.04). Vascular smooth muscle function related to aIMT and cIMT but not to urinary albumin excretion.
  
  
  CONCLUSIONS
  aIMT may be a more sensitive marker of atherosclerosis than cIMT in type 1 diabetes during mid-adolescence. Higher urinary albumin excretion, even within the normal range, is associated with early atherosclerosis and should direct clinical attention to modifiable cardiovascular risk factors.
authors: Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia.
authors: Oana
authors: O
authors: Maftei
authors: Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia Robinson Institute and Discipline of Paediatrics, University of Adelaide, Adelaide, Australia.
authors: Alexia S
authors: AS
authors: Pena
authors: School of Population Health, University of Adelaide, Adelaide, Australia.
authors: Thomas
authors: T
authors: Sullivan
authors: Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Subiaco, Australia Telethon Institute for Child Health Research, University of Western Australia, Subiaco, Australia School of Paediatrics and Child Health, University of Western Australia, Subiaco, Australia.
authors: Timothy W
authors: TW
authors: Jones
authors: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.
authors: Kim C
authors: KC
authors: Donaghue
authors: Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia Murdoch Childrens Research Institute, Melbourne, Melbourne, Australia.
authors: Fergus J
authors: FJ
authors: Cameron
authors: Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Subiaco, Australia Telethon Institute for Child Health Research, University of Western Australia, Subiaco, Australia School of Paediatrics and Child Health, University of Western Australia, Subiaco, Australia.
authors: Elizabeth
authors: E
authors: Davis
authors: Department of Paediatric Endocrinology, Mater Children's Hospital, Brisbane, Australia.
authors: Andrew
authors: A
authors: Cotterill
authors: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.
authors: Maria E
authors: ME
authors: Craig
authors: Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia.
authors: Roger
authors: R
authors: Gent
authors: WellChild Laboratory, St. Thomas' Hospital, London, U.K.
authors: Neil
authors: N
authors: Dalton
authors: Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
authors: Denis
authors: D
authors: Daneman
authors: University Department of Paediatrics, Addenbrooke's Hospital, Cambridge, U.K.
authors: David
authors: D
authors: Dunger
authors: National Centre for Cardiovascular Disease Prevention and Outcomes, University College London, London, U.K.
authors: John
authors: J
authors: Deanfield
authors: Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia Robinson Institute and Discipline of Paediatrics, University of Adelaide, Adelaide, Australia jennifer.couper@adelaide.edu.au.
authors: Jenny J
authors: JJ
authors: Couper
mesh_terms: D000293:Adolescent; D000419:Albuminuria / Q000453:epidemiology; D050197:Atherosclerosis / Q000209:etiology / Q000503:physiopathology*; D015415:Biomarkers / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D002648:Child; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL