Subclinical macroangiopathic target organ damage in type 1 diabetes mellitus patients

Figures & data

Figure 1. Measurement of cIMT.

Figure 2. CT for coronary artery calcification. (A) Calcium Score for LAD (left anterior descending) – 508; (B) Calcium Score for RCA (right coronary artery) – 154.

Figure 3. Carotid and femoral pulse waveforms, pulse wave velocity and central clinical parameters obtained by applanation tonometry.

Figure 4. Mechanisms of target organ damage in type 1 diabetes.

Table 1. Summary of main findings in studies assessing subclinical macroangiopathic target organ damage in type 1 diabetes.

Authors, Study	Journal	Findings
Assessment of intima-media thickness
Järvisalo MJ, Raitakari M, Toikka JO, et al. [20]	Circulation, 2004	subclinical cIMT changes develop early in the course of T1DM significant increase of cIMT is observed in children and adolescents with short T1DM duration
Polak JF, Backlund JC, Cleary PA, et al. DCCT/EDIC Study [28]	Diabetes, 2011	predictors of increased cIMT in T1DM patients: elevated HbA1c, increased albumin excretion rate, age, male sex, smoking, increased systolic blood pressure intensive insulin therapy slowed progression of cIMT
Gül K, Üstün I, Aydin Y, et al. [34]	Anadolu Kardiyol Derg, 2010	other predictors of increased cIMT are chronic diabetes complications – nephropathy and retinopathy as well as nocturnal hypertension
Atabek ME, Akyürek N, Eklioglu BS, et al. [37]	J Diabetes Complications, 2014
Assessment of computed tomography for coronary calcium
Raggi P, Shaw LJ, Berman DS, et al. [43]	J Am Coll Cardiol, 2004	CAC score is associated with greater increase in mortality in T1DM patients than in non-diabetics
Snell-Bergeon JK, Hokanson JE, Jensen L, et al. [49]	Diabetes Care, 2003	elevated HbA1c >7.5% is a strong risk factor of increased CAC other risk factors of increased CAC: age, male sex, increased waist-to-hip ratio, increased cIMT, hypercholesterolaemia, hypertension
Olson JC, Edmundowicz D, Becker DJ, et al. Pittsburgh EDC Study [53]	Diabetes, 2000	high sensitivity and specificity of CAC for myocardial infarction and coronary artery stenosis in T1DM strong correlation between CAC and: age, T1DM duration, systolic blood pressure and autonomic neuropathy
Assessment of arterial stiffness
Mitchell GF, Hwang SJ, Vasan RS, et al. Framingham Heart Study [62]	Circulation, 2010	significant role of PWV in improvement of CV risk prediction
Shah AS, Wadwa RP, Dabelea D, et al. Search CVD Study [67]	Pediatr Diabetes, 2015	T1DM is significantly associated with increased arterial stiffness
Prince CT, Secrest AM, Mackey RH, et al. Pittsburgh EDC Study [63, 64]	Diabetes Care, 2010	aortic augmentation pressure, aortic augmentation index and sub-endocardial viability ratio are strongly associated with autonomic neuropathy aortic augmentation index is not associated with CVD aortic augmentation pressure is significantly associated with coronary artery disease lower sub-endocardial viability ratio is correlated with a high CAC score

Järvisalo MJ, Raitakari M, Toikka JO, et al. Endothelial dysfunction and increased arterial intima-media thickness in children with type 1 diabetes. Circulation. 2004;109(14):1750–1755.

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Polak JF, for the DCCT/EDIC Research Group, Backlund JC, Cleary PA, et al. Progression of carotid artery intima-media thickness during 12 years in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Diabetes. 2011;60(2):607–613.

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Gül K, Üstün I, Aydin Y, et al. Carotid intima-media thickness and its relations with the complications in patients with type 1 diabetes mellitus. Anadolu Kardiyol Derg. 2010;10(1):52–58.

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Atabek ME, Akyürek N, Eklioglu BS, et al. Impaired systolic blood dipping and nocturnal hypertension: an independent predictor of carotid intima-media thickness in type 1 diabetic patients. J Diabetes Complications. 2014;28(1):51–55.

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Raggi P, Shaw LJ, Berman DS, et al. Prognostic value of coronary artery calcium screening in subjects with and without diabetes. J Am Coll Cardiol. 2004;43(9):1663–1669.

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Snell-Bergeon JK, Hokanson JE, Jensen L, et al. Progression of coronary artery calcification in type 1 diabetes: the importance of glycemic control. Diabetes Care. 2003;26(10):2923–2928.

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Olson JC, Edmundowicz D, Becker DJ, et al. Coronary calcium in adults with type 1 diabetes: a stronger correlate of clinical coronary artery disease in men than in women. Diabetes. 2000;49(9):1571–1578.

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Mitchell GF, Hwang SJ, Vasan RS, et al. Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation. 2010;121(4):505–511.

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Shah AS, Wadwa RP, Dabelea D, et al. Arterial stiffness in adolescents and young adults with and without type 1 diabetes: the SEARCH CVD study. Pediatr Diabetes. 2015;16(5):367–374.

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Prince CT, Secrest AM, Mackey RH, et al. Cardiovascular autonomic neuropathy, HDL cholesterol, and smoking correlate with arterial stiffness markers determined 18 years later in type 1 diabetes. Diabetes Care. 2010;33(3):652–657.

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Prince CT, Secrest AM, Mackey RH, et al. Pulse wave analysis and prevalent cardiovascular disease in type 1 diabetes. Atherosclerosis. 2010;213(2):469–474.

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