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A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Vascular function and carotid intimal-medial thickness in children with insulin-dependent diabetes mellitus
Tajinder P Singh1, Harvey Groehn, Andris Kazmers
1Division of Cardiology, Department of Pediatrics, Wayne State University, Detroit, MI 48201, USA. tsingh@dmc.org
Insights
Endothelial function is impaired in children with insulin-dependent diabetes mellitus, preceding atherosclerosis indicators like increased carotid intimal-medial thickness. This early endothelial dysfunction correlates with blood glucose and diabetes duration.
Area of Science:
- Pediatric Endocrinology
- Cardiovascular Research
- Vascular Biology
Background:
- Diabetes mellitus is a known risk factor for atherosclerosis.
- Vascular complications are not yet evident in diabetic children, but preclinical atherosclerosis is common.
- Endothelial function and carotid intima-media thickness (IMT) are indicators of preclinical atherosclerosis.
Purpose of the Study:
- To evaluate endothelium-dependent vasodilation and carotid IMT in children with insulin-dependent diabetes mellitus.
- To investigate early vascular changes in pediatric diabetes.
- To assess the relationship between endothelial function, IMT, and diabetes parameters.
Main Methods:
- Compared 31 diabetic teenagers and 35 healthy children using high-resolution vascular ultrasound.
- Assessed carotid IMT and brachial artery responses to reactive hyperemia (endothelium-dependent) and nitroglycerin (endothelium-independent).
Main Results:
- Diabetic children showed significantly lower endothelium-dependent vasodilation compared to controls (4.2% vs. 8.2%).
- No significant differences were found in endothelium-independent vasodilation or mean carotid IMT between groups.
- Impaired vasodilation correlated with higher blood glucose, longer diabetes duration, and adverse lipid profiles.
Conclusions:
- Endothelial function is impaired in children with diabetes within the first decade of onset.
- This endothelial dysfunction precedes increases in carotid IMT.
- Understanding this sequence is crucial for developing strategies to prevent atherosclerosis progression in diabetic children.
Objectives:
The objective of this study was to evaluate endothelium-dependent vasodilation and carotid intimal-medial thickness (IMT) in children with insulin-dependent diabetes mellitus.
Background:
Diabetes mellitus is an established risk factor for atherosclerosis. Vascular complications of diabetes are not clinically evident in diabetic children. However, preclinical atherosclerosis is more common in young subjects exposed to cardiovascular risk factors. Endothelial function and carotid IMT, known to be abnormal in preclinical atherosclerosis, have not been studied concurrently in a pediatric population exposed to a risk factor for atherosclerosis.
Methods:
We studied 31 diabetic teenagers (age 15.0 +/- 2.4 years; duration of diabetes 6.8 +/- 3.9 years) and 35 age-matched healthy children (age 15.7 +/- 2.7 years). Using high-resolution vascular ultrasound, we compared carotid IMT and brachial artery responses to reactive hyperemia (endothelium-dependent vasodilation) and to sublingual nitroglycerin (endothelium-independent vasodilation).
Results:
There was no difference in baseline brachial artery diameter between the two groups. Endothelium-dependent vasodilation was significantly lower in diabetic children compared with healthy children (4.2 +/- 3.8% vs. 8.2 +/- 4.2%, p < 0.001). There was no difference in endothelium-independent vasodilation (17 +/- 6% vs. 18 +/- 6%, p = NS) or mean carotid IMT between the groups (0.33 +/- 0.05 vs. 0.32 +/- 0.08 mm, p = NS). Endothelium-dependent brachial vasodilation correlated with blood glucose levels (r = 0.58, p = 0.001) and was weakly and inversely related to the duration of diabetes (r = -0.4, p = 0.02), total cholesterol, and low-density lipoprotein cholesterol levels.
Conclusions:
Endothelial function is impaired in children with diabetes mellitus within the first decade of its onset and precedes an increase in carotid IMT. The relative timing of these events is important in the evaluation of strategies to prevent progression of atherosclerosis and other vascular complications in this patient population.
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