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Item #5 

Endothelial Function Impaired In Young Diabetics

Impaired endothelial function occurs in the first 10 years of diabetes mellitus (DM) in children.

Researchers in the United States have found, that after impaired endothelial function occurs, it is followed by an increase in carotid intimal-medial thickness (IMT),
Both endothelial function and carotid IMT are known to be abnormal in preclinical atherosclerosis. The researchers underline that the relative timing of these events is critical to developing strategies to prevent progression of atherosclerosis and other vascular complications in these children.

Dr T P Singh and colleagues at Wayne State University, Detroit, Michigan, are the first to examine the two conditions concurrently in a pediatric population exposed to a risk for arteriosclerosis. Their objective was to evaluate endothelium-dependent vasodilation and carotid IMT in children with insulin-dependent DM.

Although vascular complications of diabetes are not clinically evident in diabetic children, preclinical arteriosclerosis is more common in young people exposed to cardiovascular risk factors.

Study participants were 31 diabetics in their mid-teen years (age 15 years ± 2.4; duration of diabetes 6.8 ± 3.9 years) and 35 age-matched healthy controls.

The investigators used high-resolution vascular ultrasound to compare carotid IMT and brachial artery responses to reactive hyperemia (endothelium-dependent vasodilation) and to sublingual nitroglycerin (endothelium-independent vasodilation).

Although there were no differences between the two groups in baseline brachial artery diameter, endothelium-dependent vasodilation was significantly lower in the diabetic than in the healthy children. There was no difference in endothelium-independent vasodilation or mean carotid IMT between the groups.

Endothelium-dependent brachial vasodilation correlated with blood glucose levels and was weakly and inversely related to duration of diabetes, total cholesterol and low-density lipoprotein cholesterol levels.

The relative timing of endothelial function impairment and increase in carotid IMT in these children is key to thwarting progression of atherosclerosis and other vascular complications, these authors conclude.   J Am Coll Cardiol 2003 Feb 19;41:4:661-5

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