Skip to main content
Top
Published in: Diabetology & Metabolic Syndrome 1/2016

Open Access 01-12-2016 | Research

Increased carotid intima-media thickness in Brazilian adolescents with type 1 diabetes mellitus

Authors: Maria Fernanda Gontijo Sepulveda Fusaro, Jovita Lane Soares Santos Zanini, Ivani Novato Silva

Published in: Diabetology & Metabolic Syndrome | Issue 1/2016

Login to get access

Abstract

Background

Increased carotid intima-media thickness (CIMT), a marker of subclinical atherosclerosis, is an independent predictor of future cardiovascular events, and has been reported in children with various chronic diseases, including type 1 diabetes mellitus (DM1).

Objectives

Evaluate CIMT and its association with cardiovascular risk factors in Brazilian adolescents with DM1.

Methods

Cross-sectional study of 118 adolescents, 57 with DM1 and no chronic complications related to the disease, and 61 healthy individuals. Clinical, biochemical, and high-resolution B-mode ultrasonographic evaluations according to the Consensus Statement of the American Society of Echocardiography CIMT Task Force were performed.

Results

Adolescents with diabetes (66.6% female) were 14.5 ± 2.9 years old and had 9.0 ± 4.0 years of disease duration. The healthy adolescents (62.3% female) were 14.3 ± 2.6 years old. All the adolescents had blood pressure within their reference ranges. In 66% of DM1 adolescents the systolic blood pressure was >50th percentile. Increased CIMT was observed in adolescents with diabetes compared with those in the control group: 0.53 vs 0.51 mm (p < 0.004) on the right side, and 0.55 vs 0.51 mm (p < 0.001) on the left side. CIMT presented independent and positive associations with diabetes duration, total cholesterol level, low-density lipoprotein cholesterol level, and systolic blood pressure percentile in DM1 adolescents.

Conclusions

Increased CIMT was observed in young Brazilian adolescents with DM1, and was associated with cardiovascular risk factors. CIMT assessment may be useful for the early identification and monitoring of cardiovascular risk in this age group.
Literature
1.
go back to reference Sun Y, Cai Y, Li H, Deng S, Leng R, Pan H. Increased carotid intima–media thickness (CIMT) levels in patients with type 1 diabetes mellitus (T1DM): a meta-analysis. J Diabetes Complications. 2015;29:724–30.CrossRefPubMed Sun Y, Cai Y, Li H, Deng S, Leng R, Pan H. Increased carotid intima–media thickness (CIMT) levels in patients with type 1 diabetes mellitus (T1DM): a meta-analysis. J Diabetes Complications. 2015;29:724–30.CrossRefPubMed
2.
go back to reference Krishnan P, Balamurugan A, Urbina E, Srinivasan SR, Bond G, Tang R, et al. Cardiovascular risk profile of asymptomatic healthy young adults with increased carotid artery intima-media thickness: the Bogalusa Heart Study. J La State Med Soc. 2003;155:165–9.PubMed Krishnan P, Balamurugan A, Urbina E, Srinivasan SR, Bond G, Tang R, et al. Cardiovascular risk profile of asymptomatic healthy young adults with increased carotid artery intima-media thickness: the Bogalusa Heart Study. J La State Med Soc. 2003;155:165–9.PubMed
3.
go back to reference Kavey REW, Allada V, Daniels SR, Hayman LL, McCrindle BW, Newburger JW, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on population and prevention science. Circulation. 2006;114:2710–38.CrossRefPubMed Kavey REW, Allada V, Daniels SR, Hayman LL, McCrindle BW, Newburger JW, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on population and prevention science. Circulation. 2006;114:2710–38.CrossRefPubMed
4.
go back to reference Cobble M, Bale B. Carotid intima-media thickness: knowledge and application to everyday practice. Postgrad Med. 2010;122:10–8.CrossRefPubMed Cobble M, Bale B. Carotid intima-media thickness: knowledge and application to everyday practice. Postgrad Med. 2010;122:10–8.CrossRefPubMed
5.
go back to reference Le J, Zhang D, Menees S, Chen J, Raghuveer G. “Vascular age” is advanced in children with atherosclerosis-promoting risk factors. Circ Cardiovasc Imaging. 2010;3:8–14.CrossRefPubMed Le J, Zhang D, Menees S, Chen J, Raghuveer G. “Vascular age” is advanced in children with atherosclerosis-promoting risk factors. Circ Cardiovasc Imaging. 2010;3:8–14.CrossRefPubMed
6.
go back to reference Margeirsdottir HD, Stensaeth KH, Larsen JR, Brunborg C, Dahl-Jorgensen K. Early signs of atherosclerosis in diabetic children on intensive insulin treatment: a population-based study. Diabetes Care. 2010;155:153–70. Margeirsdottir HD, Stensaeth KH, Larsen JR, Brunborg C, Dahl-Jorgensen K. Early signs of atherosclerosis in diabetic children on intensive insulin treatment: a population-based study. Diabetes Care. 2010;155:153–70.
7.
go back to reference DallaPozza R, Bechtold S, Bonfig W, Putzker S, Kozlik-Feldmann R, Netz H, et al. Age of onset of type 1 diabetes in children and carotid intima medial thickness. J Clin Endocrinol Metab. 2007;92:2053–7.CrossRef DallaPozza R, Bechtold S, Bonfig W, Putzker S, Kozlik-Feldmann R, Netz H, et al. Age of onset of type 1 diabetes in children and carotid intima medial thickness. J Clin Endocrinol Metab. 2007;92:2053–7.CrossRef
8.
go back to reference Expert Committee on the Diagnosis and Classification of. Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of Diabetes Mellitus. Diabetes Care. 1997;20:1183–97.CrossRef Expert Committee on the Diagnosis and Classification of. Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of Diabetes Mellitus. Diabetes Care. 1997;20:1183–97.CrossRef
10.
go back to reference Tanner JM. Psysical growth and development. In: Forjar JO, Amell CC, editors. Textbook of paediatrics. Livingstone: Churchill; 1978. p. 249–303. Tanner JM. Psysical growth and development. In: Forjar JO, Amell CC, editors. Textbook of paediatrics. Livingstone: Churchill; 1978. p. 249–303.
11.
go back to reference National High Blood Pressure Education Program Working group on High Blood pressure in Children and Adolescents. The fourth report on diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(Suppl 2):555–76.CrossRef National High Blood Pressure Education Program Working group on High Blood pressure in Children and Adolescents. The fourth report on diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(Suppl 2):555–76.CrossRef
12.
go back to reference Guimarães MM. Pediatric Endocrinology, a pratical guide [Endocrinologia pediátrica, guia prático]. 2nd ed. Rio de Janeiro: Rubio; 2006. p. 246–7. Guimarães MM. Pediatric Endocrinology, a pratical guide [Endocrinologia pediátrica, guia prático]. 2nd ed. Rio de Janeiro: Rubio; 2006. p. 246–7.
13.
go back to reference Sociedade Brasileira de Cardiologia. I Guidelines for Prevention of Atherosclerosis in Childhood and Adolescence [I Diretriz da Prevenção da Aterosclerose na Infância e Adolescência]. Arq Bras Cardiol. 2005;85(Suppl 6):s1–36. Sociedade Brasileira de Cardiologia. I Guidelines for Prevention of Atherosclerosis in Childhood and Adolescence [I Diretriz da Prevenção da Aterosclerose na Infância e Adolescência]. Arq Bras Cardiol. 2005;85(Suppl 6):s1–36.
14.
go back to reference American Diabetes Association. Standards of medical care in diabetes 2015. Diabetes Care. 2015;38(Suppl 1):s8–16.CrossRef American Diabetes Association. Standards of medical care in diabetes 2015. Diabetes Care. 2015;38(Suppl 1):s8–16.CrossRef
15.
go back to reference Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21:93–111.CrossRefPubMed Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21:93–111.CrossRefPubMed
16.
go back to reference Jarvisalo MJ, Jartti L, Nanto-Salonen K, Irjala K, Ronnemaa T, Hartiala JJ, et al. Increased aortic intima-media thickness: a marker of preclinical atherosclerosis in high-risk children. Circulation. 2001;104:2943–7.CrossRefPubMed Jarvisalo MJ, Jartti L, Nanto-Salonen K, Irjala K, Ronnemaa T, Hartiala JJ, et al. Increased aortic intima-media thickness: a marker of preclinical atherosclerosis in high-risk children. Circulation. 2001;104:2943–7.CrossRefPubMed
17.
go back to reference Singh TP, Groehn H, Kazmers A. Vascular function and carotid intimal-medial thickness in children with insulin-dependent diabetes mellitus. J Am Coll Cardiol. 2003;41:661–5.CrossRefPubMed Singh TP, Groehn H, Kazmers A. Vascular function and carotid intimal-medial thickness in children with insulin-dependent diabetes mellitus. J Am Coll Cardiol. 2003;41:661–5.CrossRefPubMed
18.
go back to reference Osheiba ZF, Mohammed EK, Abo-Eleneen M, Taha A, Al-Sayed R. Carotid intima-media thickness and its relations with the complications in type I diabetic children. J Am Sci. 2014;10:224–30. Osheiba ZF, Mohammed EK, Abo-Eleneen M, Taha A, Al-Sayed R. Carotid intima-media thickness and its relations with the complications in type I diabetic children. J Am Sci. 2014;10:224–30.
19.
go back to reference Maftei O, Pena AS, Sullivan T, Jones TW, Donaghue KC, Cameron FJ, et al. Early atherosclerosis relates to urinary albumin excretion and cardiovascular risk factors in adolescents with type 1 diabetes: adolescent type 1 diabetes cardiorenal intervention trial (AdDIT). Diabetes Care. 2014;37:3069–75.CrossRefPubMed Maftei O, Pena AS, Sullivan T, Jones TW, Donaghue KC, Cameron FJ, et al. Early atherosclerosis relates to urinary albumin excretion and cardiovascular risk factors in adolescents with type 1 diabetes: adolescent type 1 diabetes cardiorenal intervention trial (AdDIT). Diabetes Care. 2014;37:3069–75.CrossRefPubMed
20.
go back to reference El Dayem SMA, El Bohy AEM, Battah AA. Carotid intimal medial thickness and its relation to endothelial dysfunction and echocardiographic changes in adolescents with type 1 diabetes. J Pediatr Endocrinol Metab. 2015;28:1029–37. El Dayem SMA, El Bohy AEM, Battah AA. Carotid intimal medial thickness and its relation to endothelial dysfunction and echocardiographic changes in adolescents with type 1 diabetes. J Pediatr Endocrinol Metab. 2015;28:1029–37.
21.
go back to reference Yamasaki Y, Kawamori R, Matsushima H, Nishizawa H, Kodama M, Kajimoto Y, et al. Atherosclerosis in carotid artery of young IDDM patients monitored by ultrasound high-resolution B-mode imaging. Diabetes. 1994;43:634–9.CrossRefPubMed Yamasaki Y, Kawamori R, Matsushima H, Nishizawa H, Kodama M, Kajimoto Y, et al. Atherosclerosis in carotid artery of young IDDM patients monitored by ultrasound high-resolution B-mode imaging. Diabetes. 1994;43:634–9.CrossRefPubMed
22.
go back to reference Heilman K, Zilmer M, Zilmer K, Lintrop M, Kampus P, Kals J, et al. Arterial stiffness, carotid artery intima-media thickness and plasma myeloperoxidase level in children with type 1 diabetes. Diabetes Res Clin Pract. 2009;84:168–73.CrossRefPubMed Heilman K, Zilmer M, Zilmer K, Lintrop M, Kampus P, Kals J, et al. Arterial stiffness, carotid artery intima-media thickness and plasma myeloperoxidase level in children with type 1 diabetes. Diabetes Res Clin Pract. 2009;84:168–73.CrossRefPubMed
23.
go back to reference Salonen R, Salonen JT. Determinants of carotid intima media thickness: a population-based ultrasonography study in eastern Finnish men. J Intern Med. 1991;229:225–31.CrossRefPubMed Salonen R, Salonen JT. Determinants of carotid intima media thickness: a population-based ultrasonography study in eastern Finnish men. J Intern Med. 1991;229:225–31.CrossRefPubMed
24.
go back to reference Ishizu T, Ishimitsu T, Yanagi H, Seo Y, Obara K, Moriyama N. Effect of age on carotid arterial intima-media thickness in childhood. Heart Vessels. 2004;19:189–95.CrossRefPubMed Ishizu T, Ishimitsu T, Yanagi H, Seo Y, Obara K, Moriyama N. Effect of age on carotid arterial intima-media thickness in childhood. Heart Vessels. 2004;19:189–95.CrossRefPubMed
25.
go back to reference Lamotte C, lliescu C, Libersa C, Goltrand F. Increased intima media thickness of carotid artery in childhood a systematic review of observational studies. Eur J Pediatr. 2011;170:719–29.CrossRefPubMed Lamotte C, lliescu C, Libersa C, Goltrand F. Increased intima media thickness of carotid artery in childhood a systematic review of observational studies. Eur J Pediatr. 2011;170:719–29.CrossRefPubMed
26.
go back to reference Meyer AA, Kundt G, Lenschow U, Schuff-Werner P, Kienast W. Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol. 2006;48:1865–70.CrossRefPubMed Meyer AA, Kundt G, Lenschow U, Schuff-Werner P, Kienast W. Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol. 2006;48:1865–70.CrossRefPubMed
27.
go back to reference Bertoluci MC, Cé GV, Silva AMV, Puñales MKC. Disfunção endotelial no diabetes mellitus tipo 1. Arquivos Brasileiros de Endocrinologia e Metabologia. 2008;52:414–26.CrossRef Bertoluci MC, Cé GV, Silva AMV, Puñales MKC. Disfunção endotelial no diabetes mellitus tipo 1. Arquivos Brasileiros de Endocrinologia e Metabologia. 2008;52:414–26.CrossRef
28.
go back to reference Rabago Rodrigues R, Gómez-Díaz RA, Tanus Haj J, Avelar Garnica FJ, Ramirez Soriano E, Nishimura Meguro E, et al. Carotid intima media thickness in pediatric type 1 diabetic patients. Diabetes Care. 2007;30:2599–602.CrossRef Rabago Rodrigues R, Gómez-Díaz RA, Tanus Haj J, Avelar Garnica FJ, Ramirez Soriano E, Nishimura Meguro E, et al. Carotid intima media thickness in pediatric type 1 diabetic patients. Diabetes Care. 2007;30:2599–602.CrossRef
29.
go back to reference Krebs A, Schmidt-Trucksass A, Alt J, Doerfer J, Krebs K, Winkler K, et al. Synergistic effects of elevated systolic blood pressure and hypercholesterolemia on carotid intima-media thickness in children and adolescents. Pediatr Cardiol. 2009;30:1131–6.CrossRefPubMed Krebs A, Schmidt-Trucksass A, Alt J, Doerfer J, Krebs K, Winkler K, et al. Synergistic effects of elevated systolic blood pressure and hypercholesterolemia on carotid intima-media thickness in children and adolescents. Pediatr Cardiol. 2009;30:1131–6.CrossRefPubMed
30.
go back to reference Litwin M, Niemirska A. Intima-media thickness measurements in children with cardiovascular risk factors. Pediatr Nephrol. 2009;24:707–19.CrossRefPubMed Litwin M, Niemirska A. Intima-media thickness measurements in children with cardiovascular risk factors. Pediatr Nephrol. 2009;24:707–19.CrossRefPubMed
31.
go back to reference Urbina EM, Dabelea D, D’Agostino RB Jr, Shah AS, Dolan LM, Hamman RF, et al. Effect of type 1 diabetes on carotid structure and function in adolescents and young adults: the SEARCH CVD study. Diabetes Care. 2013;36:2597–9.CrossRefPubMedPubMedCentral Urbina EM, Dabelea D, D’Agostino RB Jr, Shah AS, Dolan LM, Hamman RF, et al. Effect of type 1 diabetes on carotid structure and function in adolescents and young adults: the SEARCH CVD study. Diabetes Care. 2013;36:2597–9.CrossRefPubMedPubMedCentral
32.
go back to reference Einarson TR, Hunchuck J, Hemels M. Relationship between blood glucose and carotid intima media thickness: a meta-analysis. Cardiovasc Diabetol. 2010;9:37–46.CrossRefPubMedPubMedCentral Einarson TR, Hunchuck J, Hemels M. Relationship between blood glucose and carotid intima media thickness: a meta-analysis. Cardiovasc Diabetol. 2010;9:37–46.CrossRefPubMedPubMedCentral
33.
go back to reference Jarvisalo MJ, Putto-Laurita A, Jartti L, Lehtimaki T, Solakivi T, Ronnemaa T, et al. Carotid artery intima-media thickness in children with type 1 diabetes. Diabetes. 2002;51:493–8.CrossRefPubMed Jarvisalo MJ, Putto-Laurita A, Jartti L, Lehtimaki T, Solakivi T, Ronnemaa T, et al. Carotid artery intima-media thickness in children with type 1 diabetes. Diabetes. 2002;51:493–8.CrossRefPubMed
34.
go back to reference Polak JF, Backlund JC, Cleary PA, Harrington AP, O’Leary DH, Lachin JM, DCCT\EDIC Research Group, et al. Progression of carotid artery intima—media thickness during 12 years in diabetes control and complications trial/Epidemiology of diabetes interventions and complications (DCCT\EDIC) study. Diabetes. 2011;60:607–13.CrossRefPubMedPubMedCentral Polak JF, Backlund JC, Cleary PA, Harrington AP, O’Leary DH, Lachin JM, DCCT\EDIC Research Group, et al. Progression of carotid artery intima—media thickness during 12 years in diabetes control and complications trial/Epidemiology of diabetes interventions and complications (DCCT\EDIC) study. Diabetes. 2011;60:607–13.CrossRefPubMedPubMedCentral
35.
go back to reference Wiegman A, de Groot E, Hutten BA. Arterial intima-media thickness in children heterozygous for familial hypercholesterolemia. Lancet. 2004;363:369–70.CrossRefPubMed Wiegman A, de Groot E, Hutten BA. Arterial intima-media thickness in children heterozygous for familial hypercholesterolemia. Lancet. 2004;363:369–70.CrossRefPubMed
36.
go back to reference The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on development and progression of long term complications in insulin- dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.CrossRef The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on development and progression of long term complications in insulin- dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.CrossRef
37.
go back to reference de Andrade Junior CR, Silva EL, da Matta MF, Castier MB, Rosa ML, Gomes MB. Influence of a family history of type 2 diabetes, demographic and clinical data on carotid intima-media thickness in patients with type 1 diabetes: a cross-sectional study. Cardiovasc Diabetol. 2014;3:13–87. de Andrade Junior CR, Silva EL, da Matta MF, Castier MB, Rosa ML, Gomes MB. Influence of a family history of type 2 diabetes, demographic and clinical data on carotid intima-media thickness in patients with type 1 diabetes: a cross-sectional study. Cardiovasc Diabetol. 2014;3:13–87.
38.
go back to reference Smith SC Jr, Greenland P, Grundy SM. AHA, Conference Proceedings. Prevention Conference V: beyond Secondary Prevention: identifying the high-risk patient for primary prevention: executive summary. American Heart Association. Circulation. 2000;101:111–6.CrossRefPubMed Smith SC Jr, Greenland P, Grundy SM. AHA, Conference Proceedings. Prevention Conference V: beyond Secondary Prevention: identifying the high-risk patient for primary prevention: executive summary. American Heart Association. Circulation. 2000;101:111–6.CrossRefPubMed
39.
go back to reference Lauer MS. Primary prevention of atherosclerotic cardiovascular disease: the high public burden of low individual risk. JAMA. 2007;297:1376–8.CrossRefPubMed Lauer MS. Primary prevention of atherosclerotic cardiovascular disease: the high public burden of low individual risk. JAMA. 2007;297:1376–8.CrossRefPubMed
40.
go back to reference US preventive Services Task Force Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. Pediatrics. 2010; 125:361–367. US preventive Services Task Force Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. Pediatrics. 2010; 125:361–367.
41.
42.
go back to reference Sthepen RD. Management of hyperlipidemia in pediatrics. Curr Opin Cardiol. 2012;27:92–7.CrossRef Sthepen RD. Management of hyperlipidemia in pediatrics. Curr Opin Cardiol. 2012;27:92–7.CrossRef
Metadata
Title
Increased carotid intima-media thickness in Brazilian adolescents with type 1 diabetes mellitus
Authors
Maria Fernanda Gontijo Sepulveda Fusaro
Jovita Lane Soares Santos Zanini
Ivani Novato Silva
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Diabetology & Metabolic Syndrome / Issue 1/2016
Electronic ISSN: 1758-5996
DOI
https://doi.org/10.1186/s13098-016-0190-0

Other articles of this Issue 1/2016

Diabetology & Metabolic Syndrome 1/2016 Go to the issue