Background: Adhesion molecules released by dysfunctional endothelium are considered as markers of vascular inflammation in early atherosclerosis. Non-invasive ultrasound methods are now available to detect first preclinical signs of the disease. Aim: To investigate the relationship between selected adhesion molecules and ultrasound indicators of early atherosclerosis: endothelial function measured by flow-mediated dilatation (FMD) and intima media thickness (IMT). Patients: The study group consisted of 85 children, mean age 14.6 years, of whom 22 were obese, 31 were hypertensive, and 32 obese and hypertensive. The control group included 26 healthy children. Methods: Adhesin concentrations were determined by ELISA. FMD and IMT were evaluated by ultrasound. Results: A positive correlation was found between sICAM-1 (soluble intercellular adhesion molecule 1) and IMT (r = 0.32, ρ = 0.013, 95% CI: 0.11 to 0.49) and a negative correlation between IMT and FMD (r = -0.26, ρ = 0.04, 95% CI: -0.43 to -0.04) in the whole study group. In the particular groups, we found significant correlations only in obese hypertensive children. sICAM-1 correlated positively with IMT (r = 0.52, ρ = 0.001, 95% CI: 0.2 to 0.72) and negatively with FMD (r = -0.31, ρ = 0.027, 95% CI: -0.6 to -0.2). sE-selectin correlated positively with IMT (r = 0.41, ρ = 0.012). In regression models, IMT correlated with sICAM-1 (β = 0.37, ρ = 0.03) and body mass index (β = 0.55, ρ = 0.02), and FMD correlated negatively with sICAM-1 (β = -0.47, ρ = 0.04). Conclusions:The association between inflammatory markers of the endothelium with impaired vasodilatation activity and the first atherosclerotic structural changes in the common carotid arteries were found in obese hypertensive children and adolescents. The coexistence of obesity and hypertension predisposes these young patients to closely related disturbances connected with early atherosclerosis.

Recent studies have shown a close correlation between advanced diabetic retinopathy and the late stages of atherosclerosis. The purpose of this study was to analyse the association between diabetic retinopathy and early atherosclerotic changes in adolescents with type 1 diabetes. We studied 28 adolescents with type 1 diabetes. Eight patients with nonproliferative retinopathy were compared with the remaining 20 patients, and with 11 healthy controls. The function of endothelium was assessed by measuring flow-mediated dilatation (FMD), the intima-media thickness (IMT) of the common carotid arteries and adhesion molecules (sICAM-1, sVCAM-1, sE-selectin). In the group with retinopathy FMD equalled 7.8+/-4.1% vs. 12.1+/-5.1% in the control group (p=0.04), and in the group without retinopathy, 7.6+/-5.5% (p=0.04 compared to controls). Higher IMT was found in all patients with diabetes in comparison with healthy controls: 0.49+/-0.06 mm vs. 0.42+/-0.03 mm (p=0.001). Patients with retinopathy had a significantly higher value of IMT in comparison not only with controls but also with patients without complications: 0.56+/-0.06 mm vs. 0.47+/-0.03 mm (p=0.0001). Adhesion molecule levels were not changed in patients with retinopathy. Higher IMT was found in adolescents with diabetic retinopathy in comparison with patients without complications, which may suggest that macrovascular changes are more advanced in these patients than in their diabetic peers without retinopathy.

Introduction: Early atheromatic changes have been found in the carotid and the femoral arteries of young adults with growth hormone (GH) deficiency (GHD). It has been shown that adults with GHD have increased cardiovascular risk factors. The aim of this study was to compare atherosclerotic risk factors in children with GHD and a normal population. Patients and Methods: Twenty-five patients (10 girls, 15 boys) with GHD qualified for GH replacement treatment were included in the study. The control group consisted of 22 healthy children (11 girls, 11 boys) with no family history of atherosclerosis and cardiovascular disease. Cardiac mass and function was evaluated by one-dimensional, two-dimensional echocardiography and the Doppler method. Common carotid intima-media thickness was measured with a linear probe (7.5 MHz). Lipid metabolism parameters (total cholesterol, HDLand LDL-cholesteroI, triglycerides), lipoprotein A (Lp(a)) and homocysteine levels were measured. Results: Cardiac dimensions and systolic parameters were within normal values in both groups. The mean index of left ventricular mass (68.37 ± 18.64 g/m 2 ) in patients with GHD did not differ significantly compared to controls (68.48 ± 15.56 g/m 2 ). No significant differences between the study and control group were observed when comparing systolic and ejection fraction values. Significantly higher mean values of IVRT parameter were found (70.8 ± 14.2 ms vs 64.09 ± 8.54% ms; ρ <0.05). Other parameters characterizing systolic function were not significantly different. The mean concentration of total (178.28 ± 31.1 mg/dl) and LDLcholesterol (106 ± 28.68 mg/dl) was significantly higher in patients with GHD than in controls (157.59 ± 22.39 mg/dl, 84.54 ± 22.01 mg/dl; ρ <0.05). Lp(a) (40.34 ± 12.45 mg/dl vs 11.02 ± 4.82 mg/dl; ρ <0.05) and apolipoprotein Β (ApoB) (71.12 ± 18 mg/dl vs 56.72 ± 11.46 mg/dl; ρ <0.05) were significantly higher in patients with GHD. Carotid artery intima-media thickness (IMT) values were significantly higher in patients with GHD compared to healthy children (IMT-L 0.53 ± 0.058 mm vs 0.41 ± 0.045 mm; IMT-R 0.54 ± 0.048 vs 0.42 ± 0.42 mm, respectively).Conclusions: No significant differences in parameters of cardiac systolic function and left ventricular mass were found between patients with GHD and healthy children. However, significantly higher Isovolumetric relaxation time (IVRT) values in the group of patients may suggest impaired diastolic function. Significantly elevated IMT values in the common carotid artery were observed in patients with GHD in comparison with healthy children, which may prove the onset of atheromatosis. KEY WORDScarotid intima media thickness, cardiac mass, cardiac function, growth deficient children

Children with type 1 diabetes (T1DM) are the high-risk group of accelerated atherosclerosis. Real-time continuous glucose monitoring (RT-CGM) provides possibilities for the detection of glycaemic variability, newly recognized cardiovascular risk factor. The aim of the study was to assess the usefulness of RT-CGM as an educational tool to find and reduce glycaemic variability in order to improve endothelial function in T1DM adolescents. Forty patients aged 14.6 years were recruited. The study was based on one-month CGM sensors use. Parameters of glycaemic variability were analyzed during first and last sensor use, together with brachial artery flow-mediated dilatation (FMD) to assess endothelial function. In the whole group, FMD improvement was found (10.9% to 16.6%, p < 0.005), together with decrease in all studied glycaemic variability parameters. In patients with HbA1c improvement compared to the group without HbA1c improvement, we found greater increase of FMD (12% to 19%, p < 0.005 versus 8.2% to 11.3%, p = 0.080) and greater improvement of glucose variability. RT-CGM can be considered as an additional tool that offers T1DM adolescents the quick reaction to decrease glycaemic variability in short time observation. Whether such approach might influence improvement in endothelial function and reduction of the risk of future cardiovascular disease remains to be elucidated.

Objective. Assessment of the effect of a treatment method change from multiple daily insulin injection (MDI) to continuous subcutaneous insulin infusion (CSII) on the development of early angiopathy in children with T1DM with or without retinopathy. Methods. The study pump group involved 32 diabetic children aged 14.8, with the initial HbA1c level of 8.3%, previously treated by MDI. The patients were examined before pump insertion and after 3 and 6 months of CSII. We assessed HbA1c level, carotid artery intima-media thickness (c-IMT), and flow-mediated dilatation (FMD) of the brachial artery. The pump group was compared to a group of eight teenagers with diagnosed nonproliferative retinopathy, treated with MDI. Results. HbA1c in the entire group was found to improve in the second and in the third examination. During 6 months of CSII, FMD increased and IMT decreased. Retinopathic adolescents had significantly thicker IMT and lower FMD compared to baseline results of the pump group. Treatment intensification in the retinopathy-free children enhanced these differences. Conclusions. CSII is associated with lower IMT and higher FMD. Whether on the long-run CSII is superior to MDI to delay the occurrence of diabetes late complications remains to be explained.