Novel risk factors in long-term hypertension incidence in type 1 diabetes mellitus

Sahakyan, Karine; Klein, Barbara E.K.; Myers, Chelsea E.; Tsai, Michael Y.; Klein, Ronald

doi:10.1016/j.ahj.2010.03.023

Cited by 23 publications

(28 citation statements)

References 57 publications

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“…Hyperhomocysteinemia is typically defined as levels >10μmol/L in reported studies [25], [26] and [27]. Levels of tHcy measured in our DCCT/EDIC cohort are comparable to observed tHcy concentrations in other studies of T1DM of similar time frame and/or participant characteristics [3], [6], [28] and [29]. While we lacked a non-diabetic control group, the observed tHcy levels in our cohort are also similar or lower than in other studies of apparently healthy non-diabetic subjects [30], and may reflect healthy dietary habits among our study participants, and for some (46%), the use of multivitamins (likely to contain tHcy-lowering B-group vitamins).…”

Section: Discussionsupporting

confidence: 77%

Plasma total homocysteine and carotid intima-media thickness in type 1 diabetes: A prospective study

et al. 2014

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OBJECTIVE Plasma homocysteine (tHcy) has been positively associated with carotid intima-media thickness (IMT) in non-diabetic populations and in a few cross-sectional studies of diabetic patients. We investigated cross-sectional and prospective associations of a single measure of tHcy with common and internal carotid IMT over a 6-year period in type 1 diabetes. RESEARCH DESIGN AND METHODS tHcy levels were measured once, in plasma obtained in 1997-1999 from patients (n=599) in the Epidemiology of Diabetes Interventions and Complications (EDIC) study, the observational follow-up of the Diabetes Control and Complications Trial (DCCT). Common and internal carotid IMT were determined twice, in EDIC “Year 6” (1998-2000) and “Year 12” (2004-2006), using B-mode ultra-sonography. RESULTS After adjustment, plasma tHcy [median (interquartile range): 6.2 (5.1, 7.5) μmol/L] was significantly correlated with age, diastolic blood pressure, renal dysfunction, and smoking (all p<0.05). In an unadjusted model only, increasing quartiles of tHcy correlated with common and internal carotid IMT, again at both EDIC time-points (p<0.01). However, multivariate logistic regression revealed no significant associations between increasing quartiles of tHcy and the 6-year change in common and internal carotid IMT (highest vs. lowest quintile) when adjusted for conventional risk factors. CONCLUSIONS In a type 1 diabetes cohort from the EDIC study, plasma tHcy measured in samples drawn in 1997-1999 was associated with measures of common and internal carotid IMT measured both one and seven years later, but not with IMT progression between the two time-points. The data do not support routine measurement of tHcy in people with Type 1 diabetes.

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Section: Discussionsupporting

confidence: 77%

Plasma total homocysteine and carotid intima-media thickness in type 1 diabetes: A prospective study

et al. 2014

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“…Our findings also suggest that sVCAM-1 seems to causally underlie the development of hypertension. This observation is in striking agreement with the only prospective study thus far that has examined CAMs and pro-inflammatory cytokines as predictors of incident hypertension among individuals with type 1 diabetes [43]. Indeed, in that study only the baseline levels of sVCAM-1 (but not sICAM-1, CRP, IL-6 and TNF-α) were associated with the 15 year cumulative incidence of hypertension.…”

Section: Discussionsupporting

confidence: 78%

Biomarkers of inflammation and endothelial dysfunction as predictors of pulse pressure and incident hypertension in type 1 diabetes: a 20 year life-course study in an inception cohort

et al. 2017

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Aims/hypothesis Vascular inflammation and endothelial dysfunction are thought to contribute to arterial stiffening and hypertension. This study aims to test this hypothesis with longitudinal data in the context of type 1 diabetes. Methods We investigated, in an inception cohort of 277 individuals with type 1 diabetes, the course, tracking and temporal inter-relationships of BP, specifically pulse pressure (a marker of arterial stiffening) and hypertension, and the following biomarkers of systemic and vascular inflammation/endothelial dysfunction: C-reactive protein (CRP), soluble intracellular adhesion molecule-1 (sICAM-1), soluble vascular cellular adhesion molecule-1 (sVCAM-1) and soluble E-selectin (sE-selectin). These biomarkers and other risk factors were measured at baseline and repeatedly up to 20 years after the onset of type 1 diabetes. Data were analysed with generalised estimating equations including adjustments for age, sex, smoking status, BMI, HbA 1c , serum creatinine, total cholesterol, urinary AER, insulin treatment dose and mean arterial pressure.Results Increases were noted in all biomarkers except sE-selectin, which decreased over time. Levels differed from baseline at 2-4 years and preceded the increase in pulse pressure, which occurred at 8-10 years after the onset of type 1 diabetes. Higher levels of sICAM-1 and sVCAM-1, but not CRP or sE-selectin, at baseline and throughout the 20 year follow-up, were significantly associated with higher (changes in) pulse pressure at subsequent time points. Higher levels of sVCAM-1 at baseline and during follow-up were also significantly associated with the prevalence (OR 3.60 of hypertension. We also investigated the longitudinal associations between BP or hypertension as determinants of subsequent (changes in) levels of CRP, sICAM-1, sVCAM-1 and sE-selectin, but did not find evidence to support a reverse causality hypothesis. Conclusions/interpretation These findings support the involvement of vascular endothelial dysfunction and inflammation in the development of premature arterial stiffening and hypertension in type 1 diabetes.

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“…However, this was not a sample with T1D. In a longitudinal study of adults with T1D, researchers found that after controlling for BMI, endothelial dysfunction was strongly associated with the development of hypertension (Sahakyan, Klein, Myers, Tsai, & Klein, 2010). Unfortunately, our data do not allow for a causal explanation of the association between these two risk factors for CVD.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular health in adults with type 1 diabetes

McCarthy

Funk

Grey

2016

Preventive Medicine

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Adults with type 1 diabetes (T1D) are at risk for cardiovascular (CV) disease. Managing CV risk is an important prevention strategy. The American Heart Association has defined 7 factors for ideal CV health. The purpose of this 2016 secondary analysis was to assess the prevalence of 6 CV health factors in a sample of adults ≥ 18 (n=7153) in the T1D Exchange Clinic registry. CV health factors include: hemoglobin A1c (HbA1c) < 7 %, BMI < 25kg/m2, blood pressure < 120/80mmHg, total cholesterol < 200mg/dl, non-smoking, and physical activity ≥ 150 minutes/week. HbA1c < 7% was substituted for the AHA health factor of fasting blood glucose. Frequencies of each factor were tabulated for the total sample and for each gender. Logistic regression examined variables associated with achievement of each CV health factor. The mean age was 37.14 ± 17 years. Mean HbA1c was 7.9 ± 1.5 %, and duration was 19.5 ± 13.5 years. The majority (54%) were working full or part-time. Achievement of CV health factors in the whole sample ranged from 27% (HbA1c < 7%) to 94% nonsmoking. Achievement of some factors varied by gender. Common variables associated with several CV health factors included gender, education, employment, and T1D duration. This young sample exhibited low levels of some CV health factors, especially HbA1c and physical activity. Providers need to routinely assess and advise on management of all CV risk factors to prevent this common diabetes complication.

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Novel risk factors in long-term hypertension incidence in type 1 diabetes mellitus

Cited by 23 publications

References 57 publications

Plasma total homocysteine and carotid intima-media thickness in type 1 diabetes: A prospective study

Plasma total homocysteine and carotid intima-media thickness in type 1 diabetes: A prospective study

Biomarkers of inflammation and endothelial dysfunction as predictors of pulse pressure and incident hypertension in type 1 diabetes: a 20 year life-course study in an inception cohort

Cardiovascular health in adults with type 1 diabetes

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