Arterial Stiffness and Type 1 Diabetes: The Current State of Knowledge

Abstract

: The most common cause of mortality among people with type 1 diabetes is cardiovascular diseases. Arterial stiffness allows predicting cardiovascular complications, cardiovascular mortality, and all-cause mortality. There are different ways to measure arterial stiffness; the gold standard is pulse wave velocity. Arterial stiffness is increased in people with type 1 diabetes compared to healthy controls. It increases with age and duration of type 1 diabetes. Arterial stiffness among people with type 1 diabetes has a positive association with systolic blood pressure, obesity, glycated hemoglobin, waist circumference, and waist to hip ratio. It has a negative correlation with estimated glomerular filtration rate, high-density lipoprotein, and the absence of carotid plaques. The increased arterial stiffness could be the result of insulin resistance, collagen increase due to inadequate enzymatic glycation, endothelial and autonomic dysfunction. The insulin-induced decrease in arterial stiffness is impaired in type 1 diabetes. There are not enough proofs to use pharmacotherapy in the prevention of arterial stiffness, but some of the medicaments have obtained promising results in single studies, for example, renin-angiotensin-aldosterone system inhibitors, statins, and SGLT2 inhibitors. The main form of prevention of arterial stiffness progression remains glycemic control and a healthy lifestyle.

Arterial Stiffness and HbA1c: Association Mediated by Insulin Resistance in Hispanic Adults

“…These findings suggested that their mechanism is determined mainly by insulin resistance due to endothelial dysfunction, an abnormal insulin vasodilating effect mediated by endothelium-derived nitric oxide [ 15 , 16 ]. It has been reported from cohort and transversal studies that HbA1c is associated and correlated with arterial stiffness assessed by PWV [ 17 , 18 , 19 ]. However, according to our research, these studies do not explore the mediator effect of insulin resistance (IR) on the association between HbA1c and PWV.…”

Endothelial Dysfunction in Diabetes Mellitus: New Insights

“…Another important finding was that patients with recently diagnosed T2DM and no cardiovascular risk factors had higher AS compared with healthy controls and, therefore, probably had premature vascular aging [ 30 ]. Some papers have also emphasized the importance of the early diagnosis of AS in T1DM and its clinical value in the prevention of CVD [ 31 ].…”