Cardiovascular Risk in Type 1 Diabetes Mellitus

Abstract

Type 1 diabetes mellitus (T1DM) is associated with premature cardiovascular disease (CVD), but the underlying mechanisms remain poorly understood. The American Diabetes Association and the European Association for the Study of Diabetes recently updated their position statement on the management of type 2 diabetes mellitus (T2DM) to include additional focus on cardiovascular risk; improved management of risk factors in T1DM is also needed. There are important differences in the pathophysiology of CVD in T1DM and T2DM. Hyperglycaemia appears to have a more profound effect on cardiovascular risk in T1DM than T2DM, and other risk factors appear to cause a synergistic rather than additive effect, so achievement of treatment targets for all recognized risk factors is crucial to reducing cardiovascular risk. Here we discuss the evidence for addressing established cardiovascular risk factors, candidate biomarkers and surrogate measurements, and possible interventions.

Coagulatory Defects in Type-1 and Type-2 Diabetes

“…Another is that stress also causes cardiovascular diseases as increased production of adrenalin and noradrenaline contribute to hypertension and hyper-coagulation, and that cholesterol is a precursor for cortisol and other steroid stress hormones [107]. However, whether this new view reflects what really happens at the molecular level is unclear as this study looked at the general population and not individuals with T1DM and T2DM, in which lipid-lowering drugs remain an essential treatment to prevent the development of complications, including cardiovascular diseases [104,105].…”

“…Plasma cholesterol, low-density lipoprotein (LDL) and triglyceride concentrations are increased and high-density lipoprotein (HDL) concentration is decreased in individuals with T2DM, and in individuals with T1DM and bad glycaemic control [103,104]. Unchanged cholesterol levels in individuals with T1DM and good glycaemic control can be deceptive as lipid profiles and functioning are altered [105,106]. Traditionally, high levels of total cholesterol and LDL have been regarded as a major risk factor of atherosclerosis and cardiovascular disease in the general population.…”

“…In diabetes, high LDL levels are associated with cardiovascular diseases, but they are not an accurate predictor of cardiovascular risks in T1DM [105,108,109]. Nevertheless, there are higher levels of "small dense LDL" in T1DM and T2DM and these forms of LDL penetrate more easily in the arterial wall than "large buoyant LDL" [110][111][112].…”

“…Furthermore, oxidized LDL inhibits endothelial nitric oxide production [114] and can more easily be taken up by macrophages as part of atherosclerotic plaque formation [112]. These characteristics are all associated with endothelial dysfunction (see Section 2.4) and cardiovascular diseases [105,112,115].…”

Mesa 1: Diabetes mellitus tipo 1 y enfermedad cardiovascular

“…La duración de la diabetes es uno de los predictores más importantes para infarto agudo de miocardio (IAM), junto con el colesterol de lipoproteínas de baja densidad (cLDL) y HbA1c. El desarrollo de DM1 antes de los 10 años de edad se asocia con un riesgo 90 veces mayor de IAM en mujeres y 30 veces mayor de ECV hacia los primeros años de su vida adulta generando una pérdida de años de vida de 17,7 y 14,2 en mujeres y hombres con DM1 respectivamente 8,9,10,11 (Figura 1).…”