Published online Jan 15, 2021. doi: 10.4239/wjd.v12.i1.56
Peer-review started: September 9, 2020
First decision: October 21, 2020
Revised: November 3, 2020
Accepted: November 18, 2020
Article in press: November 18, 2020
Published online: January 15, 2021
Type 1 diabetes (T1D) contributes to altered lipid profiles and increases the risk of cardiovascular disease (CVD). Youth with T1D may have additional CVD risk factors within the first decade of diagnosis.
To examine risk factors for dyslipidemia in young subjects with T1D.
Longitudinal and cross-sectional retrospective study of 170 young subjects with T1D (86 males; baseline mean age 12.2 ± 5.6 years and hemoglobin A1c 8.4% ± 1.4%) were followed in a single tertiary diabetes center for a median duration of 15 years. Predictors for outcomes of lipid profiles at last visit (total cholesterol [TC], triglycerides [TGs], low-density lipoprotein-cholesterol [LDL-c], and high-density lipoprotein-cholesterol [HDL-c]) were analyzed by stepwise linear regression models.
At baseline, 79.5% of the patients had at least one additional CVD risk factor (borderline dyslipidemia/dyslipidemia [37.5%], pre-hypertension/hypertension [27.6%], and overweight/obesity [16.5%]) and 41.6% had multiple (≥ 2) CVD risk factors. A positive family history of at least one CVD risk factor in a first-degree relative was reported in 54.1% of the cohort. Predictors of elevated TC: family history of CVD (β[SE] = 23.1[8.3], P = 0.006); of elevated LDL-c: baseline diastolic blood pressure (DBP) (β[SE] = 11.4[4.7], P = 0.003) and family history of CVD (β[SE] = 20.7[6.8], P = 0.017); of elevated TGs: baseline DBP (β[SE] = 23.8[9.1], P = 0.010) and family history of CVD (β[SE] = 31.0[13.1], P = 0.020); and of low HDL-c levels: baseline DBP (β[SE] = 4.8[2.1], P = 0.022]).
Our findings suggest that elevated lipid profiles are associated with DBP and a positive family history of CVD. It is of utmost importance to prevent and control modifiable risk factors such as these, as early as childhood, given that inadequate glycemic control and elevation in blood pressure intensify the risk of dyslipidemia.
Core Tip: Co-occurrence of type 1 diabetes (T1D) and cardiovascular disease (CVD) risk factor clustering (overweight/obesity, hypertension, family history of CVD and dyslipidemia) may contribute to early-onset CVD. Our findings demonstrated that most T1D patients already had at least one CVD risk factor during childhood, with dyslipidemia being the most prevalent. It is noteworthy that clustering of CVD risk factors was observed in approximately one-half of the cohort and that there was a positive family history of at least one CVD risk factor in more than 50% of the patients. The number and distribution of CVD risk factors were similar for males and females.