Early Vascular Aging in Children With Type 1 Diabetes and Ambulatory Normotension

Terezie Šuláková; Jiří Strnadel; Jan Pavlíček; Radka Poláková; Tomáš Seeman; Janusz Feber

doi:10.3389/fped.2021.764004

Early Vascular Aging in Children With Type 1 Diabetes and Ambulatory Normotension

Front Pediatr. 2021 Dec 20:9:764004. doi: 10.3389/fped.2021.764004. eCollection 2021.

Authors

Terezie Šuláková^{1

2}, Jiří Strnadel^{1

2}, Jan Pavlíček^{1

2}, Radka Poláková³, Tomáš Seeman^{4

5

6}, Janusz Feber⁷

Affiliations

¹ Department of Pediatrics, University Hospital Ostrava, Ostrava, Czechia.
² Medical Faculty University of Ostrava, Ostrava, Czechia.
³ Centre of Excellence IT4Innovations, Institute for Research and Applications of Fuzzy Modeling, University of Ostrava, Ostrava, Czechia.
⁴ Department of Pediatrics, University Hospital Motol, Prague, Czechia.
⁵ Second Medical Faculty Charles University, Prague, Czechia.
⁶ Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximillians University, Munich, Germany.
⁷ Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.

Abstract

Background: Preliminary data suggest that target organ damage (TOD) and early vascular aging (EVA) may occur in children with normal blood pressure (BP). Objectives: To analyze TOD and EVA in normotensive (BP <95th percentile on ambulatory BP monitoring) type 1 diabetes children (T1D) in comparison to healthy controls (C). Subjects: 25 T1D aged 13.9 ± 2.6 years and 22 C aged 14.0 ± 3.4 years. Methods: We analyzed age- and height-related pulse wave velocity (PWV) Z-scores and expected PWV based on age, height, and mean arterial pressure (MAP). Expected vascular age based on measured PWV was calculated from pooled pediatric and adult PWV norms. Left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR), and urinary albumin/creatinine ratio (ACR) were obtained as markers of TOD. Results: T1D and C groups did not differ in anthropometry, ambulatory, LVMI, and ACR. However, median age- and height-related PWV Z-scores were higher in T1D compared to C (1.08 vs. 0.57, p = 0.006; 0.78 vs. 0.36, p = 0.02, respectively). Mean (±SD) difference between measured and expected PWV was 0.58 ± 0.57 in T1D vs. 0.22 ± 0.59 in C, p = 0.02. The mean (±SD) difference between chronological and expected vascular age was 7.53 ± 7.74 years in T1D vs. 2.78 ± 7.01 years in C, p = 0.04. Conclusion: Increased arterial stiffness and increased intraindividual differences between expected and measured PWV as well as between chronological and expected vascular age indicate that EVA may develop in T1D children even at normal ambulatory BP levels.

Keywords: ambulatory blood pressure monitoring (ABPM); arterial stiffness; children; diabetes type 1; early vascular aging.