Preeclampsia Is Associated With Increased Preclinical Carotid Atherosclerosis in Women With Type 1 Diabetes

Abstract

Purpose Although preeclampsia (PE) is a well-established cardiovascular risk factor (CVRF) in the general population, its role in type 1 diabetes (T1D) has been scarcely studied. We assessed the association between PE and preclinical atherosclerosis in T1D. Methods We recruited 112 women without cardiovascular disease and last pregnancy ≥5 years before: (1) T1D and previous PE (T1D+/PE+; n = 28); (2) T1D without preeclampsia (T1D+/PE–; n = 28); (3) previous PE without T1D (T1D–/PE+; n = 28); and (4) controls (without T1D or PE; T1D–/PE–; n = 28). Groups were matched by age, several CVRFs, and diabetes duration and retinopathy (in T1D participants). Carotid intima-media thickness (IMT) and the presence of plaque (IMT ≥ 1.5 mm) were assessed by standardized ultrasonography protocol. Results Mean age of the participants was 44.9 ± 7.8 years (14.3% hypertension and 21.4% active smokers). Groups including T1D (T1D+/PE+ and T1D+/PE–) more frequently presented hypertension and statin treatment (23.2% vs 5.4% and 37.5% vs 8.9%; respectively; P < 0.01), without differences in other CVRFs. Carotid plaques were observed in 20.5%. In multivariate models adjusted for age, CVRF, and statins, both T1D and PE showed a similar impact on the presence of plaque, with odds ratios (95% confidence interval), 5.45 (1.36–21.9) and 4.24 (1.04–17.3), respectively. Both entities showed an additive effect when combined, both in common carotid-IMT (T1D+/PE– or T1D–/PE+, β = 0.198; T1D+/PE+, β = 0.297) and in the presence of plaque (8.53 [1.07–68.2] and 28.1 [2.67–296.4], respectively). Conclusions Previous PE was independently associated with preclinical atherosclerosis in T1D. Further studies are needed to ascertain its usefulness for stratifying risk in T1D women.

Advanced lipoprotein profile disturbances in type 1 diabetes mellitus: a focus on LDL particles

“…Thus, a recent meta-analysis showed that women with T1DM had roughly a two-fold greater excess risk of fatal and non-fatal CVD compared with T1DM men [ 32 ]. Although some gender-specific pregnancy complications may help to explain this excess risk [ 3 ], lipid factors may also be involved. In fact, in our contemporary sample, T1DM women showed a worse NMR profile, characterised by a similar amount of small LDL-P than women without T1DM; and the same LDL-P and total atherogenic particles (non-HDL-P) than men with T1DM (Table 4 ).…”

“…As is well known, LDL-cholesterol has been pointed out as a causal factor in the pathogenesis of atherosclerotic CVD in the general population [ 44 ]. Although the factors involved among the T1DM population are more complex [ 3 – 5 ], LDL-related variables remain as one of the most important lipid parameters for CVD risk [ 6 , 45 ]. In fact, this variable was strongly associated with coronary atherosclerosis in a study assessing long-standing T1DM participants [ 46 ].…”

“…However, even in those individuals with well-controlled T1DM (mean HbA1c < 7%), CVD death is roughly threefold higher compared with their non-diabetic counterparts [ 2 ]. Thus, other non-glycaemic CVD risk factors are involved in this accelerated atherosclerosis [ 3 – 5 ]. Among them, lipoprotein disturbances, especially LDL-cholesterol, are thought to be strongly related with CVD in this population.…”

Steno type 1 risk engine and preclinical atherosclerosis in Mediterranean individuals with type 1 diabetes

“…Predefined and standardized imaging protocols to evaluate carotid intima media thickness (IMT) and the presence of carotid plaque were carried out as described previously. 23,24 Carotid plaques were visualized using B-mode and colour Doppler in longitudinal and transverse planes to consider circumferential asymmetry. Carotid plaques (common carotid [CC], bulb or internal carotid [IC]) were defined as focal echo-structures encroaching into the arterial lumen by at least 50% of the surrounding IMT value, or when IMT was at least 1.5 mm as…”

Nuclear magnetic resonance lipoproteins are associated with carotid atherosclerosis in type 1 diabetes and pre‐eclampsia

“…Type 1 diabetes (T1D) is also a high CVD risk condition associated with an approximately fourfold increase in the prevalence of pre‐eclampsia 5,6 . The combination of both entities in women increases the risk of future chronic vascular complications, including micro‐ and macro‐vascular disease 7‐9 . In this setting, a previous study by our group showed an association between women with T1D and a history of pre‐eclampsia and the development of preclinical carotid atherosclerosis [either carotid intima‐media thickness (IMT) or carotid plaque] within 10 years after this obstetric complication 9 …”