Risk factors for pre-clinical atherosclerosis in adolescents with type 1 diabetes.

Aims: To assess whether, besides "traditional" risk factors, overall oxidative stress, oxidized lipoproteins, and glycemic variability are associated with early macro-vascular damage in type 1 diabetes (T1D).

Methods: In 267 children/adolescents with T1D (130 girls, age 9.1-23.0 years) we evaluated: derivatives of reactive oxygen metabolites [d-ROMs], serum total antioxidant capacity [TAC] and oxidized LDL-cholesterol [oxLDL]; markers of early vascular damage (Lipoprotein-associated phospholipase A2 [Lp-PLA2], z-score of carotid intima-media thickness [z-cIMT] and carotid-femoral pulse wave velocity [z-PWV]); CGM metrics of four weeks preceding the visit, central systolic/diastolic blood pressures (cSBP/cDBP), and HbA1c, z-score of BP (z-SBP/z-DBP) and circulating lipids longitudinally collected since T1D onset.. Three general linear models were built with z-cIMT, z-PWV adjusted for current cDBP, and Lp-PLA2 as independent variables.

Results: The z-cIMT was associated with male gender (B = 0.491, η = 0.029, p = 0.005), cSBP (B = 0.023, η = 0.026, p = 0.008) and oxLDL (B = 0.022, η = 0.022, p = 0.014). The z-PWV was associated with diabetes duration (B = 0.054, η = 0.024, p = 0.016), daily insulin dose (B = 0.52, η = 0.018, p = 0.045), longitudinal z-SBP (B = 0.18, η = 0.018, p = 0.045) and dROMs (B = 0.003, η = 0.037, p = 0.004). Lp-PLA2 was associated with age (B = 0.221, η = 0.079, p = 3*10), oxLDL (B = 0.081, η = 0.050, p = 2*10), longitudinal LDL-cholesterol (B = 0.031, η = 0.043, p = 0.001) and male gender (B = -1.62, η = 0.10, p = 1.3*10).

Conclusions: Oxidative stress, male gender, insulin dose, diabetes duration and longitudinal lipids and blood pressure, contributed to the variance of early vascular damage in young patients with T1D.