Lipoprotein-associated phospholipase A2 activity and low-density lipoprotein subfractions after a 2-year treatment with atorvastatin in adolescents with type 1 diabetes.

BACKGROUND: The objective of the study was to assess the effect of atorvastatin on inflammation markers and low-density lipoprotein (LDL) subfractions. METHODS: In a prospective, randomized, double-blind pilot study involving 28 adolescents with type 1 diabetes (T1D), lipoprotein-associated phospholipase A2 (Lp-PLA2) activity, high-sensitivity C-reactive protein (hsCRP), and subfractions of LDL were measured at baseline, after 1 year and 2 years of treatment with atorvastatin (10 mg/day) vs. placebo. RESULTS: For the atorvastatin group, we found posttreatment reductions of Lp-PLA2 activity (p<0.001), LDL cholesterol (p=0.001), non-small dense LDL cholesterol (p<0.001), total cholesterol (p<0.001), and apolipoprotein B (apo B) (p<0.001), whereas small dense LDL cholesterol and hsCRP did not change significantly. CONCLUSIONS: In adolescents with T1D, long-term treatment with atorvastatin is safe and may reduce cardiovascular risk by significant decreases of Lp-PLA2 activity and LDL cholesterol.

Cardiovascular risk in pediatric type 1 diabetes: sex-specific intima-media thickening verified by automatic contour identification and analyzing systems.

OBJECTIVES: To improve screening and quantification of subclinical atherosclerosis in children and adolescents with type 1 diabetes (T1D), we investigated the distribution of cardiovascular risk factors (cRFs) and carotid intima-media thickness (cIMT) percentiles with regard to sex-specific differences. METHODS: This cross-sectional analysis included clinical parameters, blood lipids, and B-mode ultrasound examination of the bilateral mean cIMT using an automatic contour identification procedure combined with computerized analysis. RESULTS: A total of 270 patients were eligible for evaluation (126 females, mean age 13.7 yr; 144 males, mean age 13.8 yr). In the total group, cIMT was significantly related to sex and diabetes duration but not to age. In males, cIMT was significantly higher than in females and sex-specific cIMT percentiles were calculated. Both pulse pressure and diabetes duration in boys and low-density lipoprotein (LDL)-cholesterol, hemoglobin A1c (HbA1c), and diabetes duration in girls showed a significant association with cIMT. CONCLUSIONS: On the basis of sex differences of cRFs and cIMT in pediatric T1D, the assessment of sex-specific IMT percentiles facilitates a differentiated interpretation of subclinical atherosclerosis. The underlying diabetes and additional cRFs seem to be more important determinants of intima-media thickening than age. To improve the comparability of IMT measurements of relevant studies, the international harmonization of IMT measurements should be aimed for.

Characterization of 33 488 children and adolescents with type 1 diabetes based on the gender-specific increase of cardiovascular risk factors.

OBJECTIVES: Characterization of children with type 1 diabetes (T1DM) regarding number and gender distribution of cardiovascular risk factors (cvRF) and of total cholesterol/high-density lipoprotein cholesterol ratio (TC/HDL-C ratio) for risk assessment. METHODS: 33488 patients 200 mg/dL, >5.17 mmol/L; and/or HDL-C <35 mg/dL, <0.91 mmol/L; and/or LDL-C >130 mg/dL, >3.36 mmol/L), elevated systolic and/or diastolic blood pressure (BP) >or=90th percentile, obesity >97th percentile, active smoking, and HbA1c >or=7.5% were considered as cvRF. RESULTS: 65% had no or 1 cvRF. HbA1c >/=7.5% was the most frequently occurring cvRF followed by BP >or=90th percentile, dyslipidemia, smoking, and BMI >97th percentile. Age at diabetic onset ranged from 7.7 to 9.2 years and diabetes duration from 4.1 to 6.6 years. CvRF showed differences in disfavour of females except smoking and HDL-C <35 mg/dL (0.91 mmol/L). Rate of females was 45% with 0 cvRF and 60% with 4 to 5 cvRF. TC/HDL-C ratio showed no clear association to the number of cvRF. CONCLUSIONS: 35% of a pediatric T1DM population develops 2 or more cvRF thus increasing their cv risk in adulthood. With increasing numbers of cvRF, the percentage of girls is rising from 45% to 60% which might contribute to an assimilation of survival rates in female and male adults. TC/HDL ratio does not predict the extent of cardiovascular risk in pediatric T1DM.