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Study of coronary artery calcification risk in Egyptian adolescents with type-1 diabetes

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Abstract

The objective of the study is to assess coronary artery calcification (CAC) among adolescents with type-1 diabetes and to determine its relation with high-sensitivity C-reactive protein (hs-CRP), dyslipidaemia, glycaemic control and microvascular complications. The study included sixty patients with type-1 diabetes. Their ages ranged from 12 to 18 years and their diabetes duration ranged between 10 and 15 years. Patients were compared with 60 healthy subjects who served as controls. Clinical examination and laboratory investigations were done for evaluation of glycaemic control and presence of microvascular complications. Lipid profile, hs-CRP and multislice spiral computed tomography were done. Hs-CRP, total cholesterol, triglycerides and low-density lipoproteins levels were significantly higher in patients with diabetes compared to controls (P < 0.001). Twelve patients with diabetes (20%) had positive CAC. The mean calcium score was significantly higher in patients with diabetes compared to controls (P < 0.05). Smoking significantly affects CAC as 50% of smokers with diabetes had evidence of CAC compared to 9.1% of non-smokers with diabetes (P < 0.001). Fifty percent of patients with diabetes on angiotensin-converting enzyme inhibitor (ACEI) had evidence of CAC compared to 0% of patients without history of ACEI therapy (P < 0.001). Diabetics with CAC had significantly elder age, longer disease duration and higher mean glycosylated hemoglobin compared to diabetics without CAC (P < 0.05). Blood pressure percentiles, albumin creatinine ratio and serum lipids were significantly higher in patients with CAC compared to those without CAC (P < 0.001). All diabetics with severe retinopathy had positive CAC compared to 0% with normal Fundus (P < 0.001). All diabetics with overt nephropathy had positive CAC compared to 13.3% and 0% in micro- and normo-albuminuric patients (P < 0.001). Young patients with diabetes have evidence of CAC. Smoking, microvascular complications and dyslipidaemia might contribute to this risk.

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References

  1. Raggi P, Bellasi A, Ratti C (2005) Ischemia imaging and plaque imaging in diabetes complementary tools to improve cardiovascular risk management. Diabetes Care 28(11):2787–2794

    Article  PubMed  Google Scholar 

  2. Tarquini R, Lazzeri C, Pala L, Maria Rotella C, Franco Gensini G (2010) The diabetic cardiomyopathy. Acta Diabetol, online first, March, 2010

  3. Sicree R, Shaw J, Zimmet P (2006) Diabetes and impaired glucose tolerance. In: Gan D (ed) Diabetes atlas, 3rd edn. International Diabetes Federation, Brussels, pp 15–109

    Google Scholar 

  4. Retnakaran R et al (2006) Risk factors for renal dysfunction in type 2 diabetes: U.K. prospective diabetes study 74. Diabetes 55(6):1832–1839

    Article  PubMed  CAS  Google Scholar 

  5. Atkins RC, Zimmet P (2010) Diabetic kidney disease: act now or pay later. Acta Diabetol 47:1–4

    Article  PubMed  Google Scholar 

  6. Snell-Bergeon JK, Hokanson JE, Jensen L, MacKenzie T, Kinney G, Dabelea D, Eckel RH, Ehrlich J, Garg S, Rewers M (2003) Progression of coronary artery calcification in type 1 diabetes: the importance of glycemic control. Diabetes Care 26(10):2923–2928

    Article  PubMed  Google Scholar 

  7. Cleary PA, Orchard TJ, Genuth S, Wong ND, Detrano R, Backlund JC, Zinman B, for the DCCT/EDIC Research Group et al (2006) The effect of intensive glycemic treatment on coronary artery calcification in Type 1 Diabetic Participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study. Diabetes 55(12):3556–3565

    Article  PubMed  CAS  Google Scholar 

  8. Orchard TJ, Olson JC, Erbey JR, Williams K, Forrest KY, Smithline Kinder L, Ellis D, Becker DJ (2003) Insulin resistance-related factors, but not glycemia, predict coronary artery disease in type 1 diabetes: 10-year follow-up data from the Pittsburgh Epidemiology of Diabetes Complications study. Diabetes Care 26:1374–1379

    Article  PubMed  Google Scholar 

  9. Festa A, Haffner SM (2005) Inflammation and cardiovascular disease in patients with diabetes: lessons from the diabetes control and complications trial. Circulation 111:2414–2415

    Article  PubMed  Google Scholar 

  10. Haffner SM (2003) Statin therapy for the treatment of diabetic dyslipidemia. Diabetes Metab Res Rev 19(4):280–287

    Article  PubMed  CAS  Google Scholar 

  11. Wadwa RP, Kinney GL, Maahs DM, Snell-Bergeon J, Hokanson JE, Garg SK et al (2005) Awareness and treatment of dyslipidemia in young adults with Type 1 diabetes. Diabetes Care 28(5):1051–1056

    Article  PubMed  Google Scholar 

  12. Cerbone AM, Macarone-Palmieri EG, Saldalamacchia EA, Coppola E, Di Minno E, Rivellese AA (2009) Diabetes, vascular complications and antiplatelet therapy: open problems. Acta Diabetol 46:253–261

    Article  PubMed  CAS  Google Scholar 

  13. Tsioufis C, Dimitriadis K, Taxiarchou E, Vasiliadou C, Chartzoulakis G, Tousoulis D, Manolis A, Stefanadis C, Kallikazaros I (2006) Diverse associations of microalbuminuria with C-reactive protein, interleukin-18 and soluble CD 40 ligand in male essential hypertensive subjects. Am J Hypertens 19(5):462–466

    Article  PubMed  CAS  Google Scholar 

  14. Bar N, Erdogan M, Sezer E, Saygih F, Mert Özgönül A, Turgan N, Ersöz B (2009) Alterations in l-arginine and inflammatory markers in type 2 diabetic patients with and without microalbuminuria. Acta Diabetol 46:309–316

    Article  Google Scholar 

  15. Colhoun HM, Schalkwijk C, Rubens MB, Stehouwer CDA (2002) C-reactive protein in type 1 diabetes and its relationship to coronary artery calcification. Diabetes Care 25(10):1813–1817

    Article  PubMed  CAS  Google Scholar 

  16. Nasir K, Budoff MJ, Post WS, Fishman EK, Mahesh M, Lima JA, Blumenthal RS (2003) Electron beam CT versus helical CT scans of coronary arteries: current utility and future directions. Am Heart J 146(6):949–977

    Article  Google Scholar 

  17. Schmermund A, Möhlenkamp S, Stang A, Grönemeyer D, Seibel R, Hirche H, Mann K, Siffert W, Lauterbach K, Siegrist J, Jöckel KH, Erbel R et al (2002) Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf Recall Study. Risk factors, evaluation of coronary calcium and lifestyle. Am Heart J 144(2):212–218

    Article  PubMed  Google Scholar 

  18. Lawlor DA, Whincup P, Emberson JR, Rees K, Walker M, Ebrahim S (2004) The challenge of secondary prevention for coronary heart disease in older patients: findings from the British Women’s Heart and Health Study and the British Regional Heart Study. Fam Pract 21(5):582–586

    Article  PubMed  Google Scholar 

  19. World Health Organization Expert Committee on Diabetes Mellitus (1980) Second Report, Technical Report Series. WHO, Geneva

    Google Scholar 

  20. Diabetes Endocrine and Metabolic Unit and the National Research Center (2003) Cairo University. In: Collaboration with Wright State University. School of Medicine. Department of community health life span. Health research center. From a total sample size of 33189 girls and boys

  21. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(2 pt 2):555–576

    Article  Google Scholar 

  22. American Diabetes Association (2008) ADA. Clinical guidelines comments. Bernstein RK. http://www.diabetes.org

  23. Tabaei B, Al-Kassab A, Zawaski C, Herman W (2001) Does microalbuminuria predict diabetic nephropathy? Diabetic Care 24(9):1560–1566

    Article  CAS  Google Scholar 

  24. Allain CC, Poom LS, Chan CSG et al (1974) Enzymatic determination of total serum cholesterol. Clin Chem 20(4):470–475

    PubMed  CAS  Google Scholar 

  25. Wahlefeld AW (1974) Triglycerids determination after enzymatic hydrolysis. In: Bergmeyer HU (ed) Methods of enzymatic analysis, 2nd edn. Academic Press, New York, pp 1831–1835

    Google Scholar 

  26. Harley CR, Gandhi SK, Heien H et al (2008) Lipid levels and low-density lipoprotein cholesterol goal attainment in diabetic patients: rosuvastatin compared with other statins in usual care. Expert Opin Pharmacother 9:669–676

    Article  PubMed  CAS  Google Scholar 

  27. Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18(6):499–502

    PubMed  CAS  Google Scholar 

  28. Brian C, Olshaker JS (1999) The C-reactive protein. J Emerg Med 17(6):1019–1025

    Article  Google Scholar 

  29. Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ (2003) Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 228(3):826–833

    Article  PubMed  Google Scholar 

  30. Schurgin S, Rich S, Mazzone T (2001) Increased prevalence of significant coronary artery calcification in patients with diabetes. Diabetes Care 24(2):335–338

    Article  PubMed  CAS  Google Scholar 

  31. Soedamah-Muthu SS, Chaturvedi N, Toeller M, Ferriss B, Reboldi P, Michel G, Manes C, Fuller JH (2004) EURODIAB Prospective Complications Study Group. Risk factors for coronary heart disease in type 1 diabetic patients in Europe: the EURODIAB Prospective Complications Study. Diabetes Care 27(2):530–537

    Article  PubMed  Google Scholar 

  32. Rumberger JA, Sheedy PF II, Breen JF, Fitzpatrick LA, Schwartz RS (1996) Electron beam computed tomography and coronary artery disease: scanning for coronary artery calcification. Mayo Clin Proc 71:369–377

    Article  PubMed  CAS  Google Scholar 

  33. American College of Radiology & Radiological Society of North America (2006) ACR & RSNA. Cardiac CT for calcium scoring. Radiology info. http://www.radiologyinfo.org

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

    Article  PubMed  CAS  Google Scholar 

  35. Hong YJ, Jeong MH, Choi YH, Ko JS, Lee MG, Kang WY et al (2009) Plaque characteristics in culprit lesions and inflammatory status in diabetic acute coronary syndrome patients. J Am Coll Cardiol Imag 2:339–349

    Google Scholar 

  36. Starkman HS, Cable G, Hala V, Hecht H, Donnelly CM (2003) Delineation of prevalence and risk factors for early coronary artery disease by electron beam computed tomography in young adults with type 1 diabetes. Diabetes Care 26(2):433–436

    Article  PubMed  Google Scholar 

  37. Tunstall-Pedoe H, Vanuzzo D, Hobbs M, Mahonen M, Ceoautus Z, Kuulasmaa K, Keil U, for the WHO MONICA Project (2000) Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations. Lancet 355:688–700

    Article  PubMed  CAS  Google Scholar 

  38. Fuller JH, Stevens LK, Wang SL (2001) Risk factors for cardiovascular mortality and morbidity: the WHO Mutinational Study of vascular disease in diabetes. Diabetologia 44(S2):S54–S64

    Article  PubMed  CAS  Google Scholar 

  39. Lee CD, Jacobs DR, Lee C-D, Schreiner PJ, Iribarren C, Arlene Hankinson A (2007) Abdominal obesity and coronary artery calcification in young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study 1–3. Am J Clin Nutr 86(1):48–54

    PubMed  CAS  Google Scholar 

  40. Prince CT, Becker DJ, Costacou T, Miller RG, Orchard TJ (2007) Changes in glycaemic control and risk of coronary artery disease in type 1 diabetes mellitus: findings from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC). Diabetologia 50(11):2280–2288

    Article  PubMed  CAS  Google Scholar 

  41. Bishop FK, Maahs DM, Snell-Bergeon JK, Ogden LG, Kinney GL, Rewers M (2009) Lifestyle risk factors for atherosclerosis in adults with type 1 diabetes. Diabetes Vasc Dis Res 6(4):269–275

    Article  Google Scholar 

  42. International Society of Pediatric & Adolescent Diabetes. ISPAD (2007) Clinical practice consensus Guidelines for microvascular and macrovascular complications. Pediatr Diabetes 8(3):163–170

    Article  Google Scholar 

  43. Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Power NR, Golden SH (2004) Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 141:421–431

    PubMed  CAS  Google Scholar 

  44. Mehrotra R, Budoff M, Christenson P, Ipp E, Takasu J, Gupta A, Norris K, Adler S (2004) Determinants of coronary artery calcification in diabetics with and without nephropathy. Kidney Int 66(5):2022–2031

    Article  PubMed  Google Scholar 

  45. Oğuz A, Damcı T, Pehlivanoğlu S, Kültürsay H, Tokgözoğlu L, Şenocak M et al (2009) The impact of diabetes and coronary artery disease on mortality and morbidity in patients with hypertension. Türk Kardiyol Dern Arş Arch 37(4):221–225

    Google Scholar 

  46. Maahs DM, Snell-Bergeon JK, Kinney GL, Wadwa RP, Garg S, Ogden LG, Rewers M (2007) ACE-I/ARB treatment in type 1 diabetes patients with albuminuria is associated with lower odds of progression of coronary artery calcification. J Diabetes Complicat 21(5):273–279

    Article  PubMed  Google Scholar 

  47. Cheung N, Wang JJ, Klein R, Couper DJ, Sharrett AR, Wong TY (2007) Diabetic retinopathy and the risk of coronary heart disease the Atherosclerosis Risk in Communities Study. Diabetes Care 30(7):1742–1746

    Article  PubMed  Google Scholar 

  48. Klein BEK, Klein R, McBride PE, Cruickshanks KJ, Palta M, Knudtson ML, Moss SE, Reinke JO (2004) Cardiovascular disease, mortality, and retinal microvascular characteristics in type 1 diabetes. Arch Intern Med 164:1917–1924

    Article  PubMed  Google Scholar 

  49. Krishna P, Roopakola SM, Kumar KMP (2005) Dyslipidemia in type 1 diabetes mellitus in the young. Int J Diab Dev Ctries 25(4):110–112

    Article  Google Scholar 

  50. Perez A, Wagner AM, Carreras G, Gimenez G, Sanchez-Quesada JL, Rigla M, Gomez-Gerique JA, Pou JM, de Leiva A (2000) Prevalence and phenotypic distribution of dyslipidemia in type 1 diabetes mellitus: effect of glycemic control. Arch Intern Med 160(18):2756–2762

    Article  PubMed  CAS  Google Scholar 

  51. Petri A, Lusignan S, Williams J, Chan T, Majeed A (2006) Management of cardiovascular risk factors in people with diabetes in primary care: cross-sectional study. Public Health 120(7):654–663

    Article  PubMed  Google Scholar 

  52. Wong ND, Kawakubo M, LaBree L, Azen SP, Xiang M, Detrano R (2004) Relation of coronary calcium progression and control of lipids according to National Cholesterol Education Program guidelines. Am J Cardiol 94(4):431–436

    Article  PubMed  CAS  Google Scholar 

  53. Coulon J, Willems D, Dorchy H (2005) Increase in C-reactive protein plasma levels during diabetes in infants and young adults. Presse Med 34(2 Pt 1):89–93

    Article  PubMed  CAS  Google Scholar 

  54. Soedamah-Muthu SS, Stehouwer CD (2005) Cardiovascular disease morbidity and mortality in patients with type 1 diabetes mellitus: management strategies. Treat Endocrinol 4(2):75–86

    Article  PubMed  Google Scholar 

  55. Hosseinsabet A, Mohebbi A, Almasi A (2008) C-reactive protein and coronary calcium score. Association in coronary artery disease. Cardiol J 15(5):431–436

    Google Scholar 

  56. Collins R, Armitage J, Parish S, Sleigh P, Peto R, the Heart Protection Study Collaborative Group (2003) MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 361:2005–2016

    Article  PubMed  Google Scholar 

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Salem, M., Moneir, I., Adly, A.M. et al. Study of coronary artery calcification risk in Egyptian adolescents with type-1 diabetes. Acta Diabetol 48, 41–53 (2011). https://doi.org/10.1007/s00592-010-0214-4

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  • DOI: https://doi.org/10.1007/s00592-010-0214-4

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