title: Interventions to Reduce Cardiovascular Risk in Children with Type 1 Diabetes.
abstract: BACKGROUND
  Despite recent advances in improved glycemic control, the magnitude of lifetime risk from premature cardiovascular disease in individuals with type 1 diabetes remains at least 10 fold higher than in the general population. The availability of lipoprotein fractionation has allowed the spotlight for this increased risk to shift from dysglycemia to diabetes-induced dyslipidemia associated with insulin resistance. Interventions designed to simultaneously improve both factors can have distinct and additive effects on slowing the initiation and progression of atherosclerotic lesions. As fullblown cardiovascular disease is not evident during childhood, there is a critical need to identify the most predictable surrogate markers that could assign elevated risk, as well as the design of safe and targeted interventions that could improve outcomes in this population.
  
  
  CONCLUSIONS
  This review will examine the evidence supporting the notion that cardiovascular disease in type 1 diabetes is associated with significant insulin resistance and it begins in childhood, making it necessary to design rational clinical trials that will significantly reduce risk in this population.
authors.affiliation: Pediatric Endocrinology, Diabetes & Metabolism, Nemours Children' s Health System, Jacksonville, FL. United States.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Canas
authors.affiliation: Nemours Cardiac Center, A. I. Dupont Hospital for Children, Wilmington, DE. United States.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Gidding
authors.affiliation: Pediatric Endocrinology, Diabetes & Metabolism, Nemours Children's Health System, 807 Children' s Way, Jacksonville, FL 32207. United States.
authors.forename: Nelly
authors.initials: N
authors.lastname: Mauras
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007333:Insulin Resistance; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D040242:Risk Reduction Behavior
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular disease; HbA1c; dyslipidemia; insulin resistance; lipoproteins; statins; systematic review; type 1
  diabetes