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Preventing Cardiovascular Complications in Type 1 Diabetes: The Need for a Lifetime Approach

Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in individuals with type 1 diabetes (T1D). Adolescence appears to be a critical time for the development of early subclinical manifestations of CVD, with these changes likely driven by a deterioration in glycemic control...

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Autores principales: Chiesa, Scott T., Marcovecchio, M. Loredana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219852/
https://www.ncbi.nlm.nih.gov/pubmed/34178905
http://dx.doi.org/10.3389/fped.2021.696499
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author Chiesa, Scott T.
Marcovecchio, M. Loredana
author_facet Chiesa, Scott T.
Marcovecchio, M. Loredana
author_sort Chiesa, Scott T.
collection PubMed
description Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in individuals with type 1 diabetes (T1D). Adolescence appears to be a critical time for the development of early subclinical manifestations of CVD, with these changes likely driven by a deterioration in glycemic control during the progression through puberty, combined with the emergence of numerous other traditional cardiometabolic risk factors (e.g., hypertension, dyslipidemia, smoking, alcohol use, obesity, etc.) which emerge at this age. Although hemoglobin A1C has long been the primary focus of screening and treatment strategies, glycemic control remains poor in youth with T1D. Furthermore, screening for cardiovascular risk factors—which are often elevated in youth with T1D—is suboptimal, and use of pharmacological interventions for hypertension and dyslipidemia remains low. As such, there is a clear need not only for better screening strategies for CVD risk factors in youth, but also early interventions to reduce these, if future CVD events have to be prevented. Accumulating evidence has recently suggested that early increases in urinary albumin excretion, even within the normal range, may identify adolescents with T1D who are at an increased risk of complications, and results from pharmacological intervention with statins and ACE inhibitors in these individuals have been encouraging. These data join a growing evidence highlighting the need for a whole-life approach to prevention starting from childhood if efforts to improve CVD outcomes and related mortality in T1D are to be maintained.
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spelling pubmed-82198522021-06-24 Preventing Cardiovascular Complications in Type 1 Diabetes: The Need for a Lifetime Approach Chiesa, Scott T. Marcovecchio, M. Loredana Front Pediatr Pediatrics Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in individuals with type 1 diabetes (T1D). Adolescence appears to be a critical time for the development of early subclinical manifestations of CVD, with these changes likely driven by a deterioration in glycemic control during the progression through puberty, combined with the emergence of numerous other traditional cardiometabolic risk factors (e.g., hypertension, dyslipidemia, smoking, alcohol use, obesity, etc.) which emerge at this age. Although hemoglobin A1C has long been the primary focus of screening and treatment strategies, glycemic control remains poor in youth with T1D. Furthermore, screening for cardiovascular risk factors—which are often elevated in youth with T1D—is suboptimal, and use of pharmacological interventions for hypertension and dyslipidemia remains low. As such, there is a clear need not only for better screening strategies for CVD risk factors in youth, but also early interventions to reduce these, if future CVD events have to be prevented. Accumulating evidence has recently suggested that early increases in urinary albumin excretion, even within the normal range, may identify adolescents with T1D who are at an increased risk of complications, and results from pharmacological intervention with statins and ACE inhibitors in these individuals have been encouraging. These data join a growing evidence highlighting the need for a whole-life approach to prevention starting from childhood if efforts to improve CVD outcomes and related mortality in T1D are to be maintained. Frontiers Media S.A. 2021-06-09 /pmc/articles/PMC8219852/ /pubmed/34178905 http://dx.doi.org/10.3389/fped.2021.696499 Text en Copyright © 2021 Chiesa and Marcovecchio. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Chiesa, Scott T.
Marcovecchio, M. Loredana
Preventing Cardiovascular Complications in Type 1 Diabetes: The Need for a Lifetime Approach
title Preventing Cardiovascular Complications in Type 1 Diabetes: The Need for a Lifetime Approach
title_full Preventing Cardiovascular Complications in Type 1 Diabetes: The Need for a Lifetime Approach
title_fullStr Preventing Cardiovascular Complications in Type 1 Diabetes: The Need for a Lifetime Approach
title_full_unstemmed Preventing Cardiovascular Complications in Type 1 Diabetes: The Need for a Lifetime Approach
title_short Preventing Cardiovascular Complications in Type 1 Diabetes: The Need for a Lifetime Approach
title_sort preventing cardiovascular complications in type 1 diabetes: the need for a lifetime approach
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219852/
https://www.ncbi.nlm.nih.gov/pubmed/34178905
http://dx.doi.org/10.3389/fped.2021.696499
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