Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jan 15, 2021; 12(1): 56-68
Published online Jan 15, 2021. doi: 10.4239/wjd.v12.i1.56
Dyslipidemia and cardiovascular disease risk factors in patients with type 1 diabetes: A single-center experience
Sari Krepel Volsky, Shlomit Shalitin, Elena Fridman, Michal Yackobovitch-Gavan, Liora Lazar, Rachel Bello, Tal Oron, Ariel Tenenbaum, Liat de Vries, Yael Lebenthal
Sari Krepel Volsky, Shlomit Shalitin, Elena Fridman, Michal Yackobovitch-Gavan, Liora Lazar, Rachel Bello, Tal Oron, Ariel Tenenbaum, Liat de Vries, Yael Lebenthal, National Center for Childhood Diabetes, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach-Tikva 4920235, Israel
Shlomit Shalitin, Liora Lazar, Ariel Tenenbaum, Liat de Vries, Yael Lebenthal, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
Author contributions: Krepel Volsky S contributed to the data used in the study, searched the literature, interpreted the data, and wrote the initial draft of the manuscript; Shalitin S, Fridman E, Lazar L, Bello R, Oron T, Tenenbaum A, and de Vries L contributed to the data used in this article, contributed to the discussion, and reviewed and edited the manuscript; Yackobovitch-Gavan M analyzed and interpreted the data, contributed to the discussion, and reviewed and edited the manuscript; Lebenthal Y designed the study, contributed to the data used in this article, contributed to the discussion, and reviewed and edited the manuscript; Krepel Volsky S is the guarantor of this work, and thus had full access to all of the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis; All authors approved the final version.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board at Rabin Medical Center, approval No. 0075-17-RMC.
Informed consent statement: The authors received a waiver from the EC form obtaining informed consent from participants as the study is a non-interventional retrospective study collecting non-identified data.
Conflict-of-interest statement: All authors confirm that no potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shlomit Shalitin, MD, Professor, National Center for Childhood Diabetes, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach-Tikva 4920235, Israel. shlomits2@clalit.org.il
Received: September 9, 2020
Peer-review started: September 9, 2020
First decision: October 21, 2020
Revised: November 3, 2020
Accepted: November 18, 2020
Article in press: November 18, 2020
Published online: January 15, 2021
Processing time: 119 Days and 19.7 Hours
Abstract
BACKGROUND

Type 1 diabetes (T1D) contributes to altered lipid profiles and increases the risk of cardiovascular disease (CVD). Youth with T1D may have additional CVD risk factors within the first decade of diagnosis.

AIM

To examine risk factors for dyslipidemia in young subjects with T1D.

METHODS

Longitudinal and cross-sectional retrospective study of 170 young subjects with T1D (86 males; baseline mean age 12.2 ± 5.6 years and hemoglobin A1c 8.4% ± 1.4%) were followed in a single tertiary diabetes center for a median duration of 15 years. Predictors for outcomes of lipid profiles at last visit (total cholesterol [TC], triglycerides [TGs], low-density lipoprotein-cholesterol [LDL-c], and high-density lipoprotein-cholesterol [HDL-c]) were analyzed by stepwise linear regression models.

RESULTS

At baseline, 79.5% of the patients had at least one additional CVD risk factor (borderline dyslipidemia/dyslipidemia [37.5%], pre-hypertension/hypertension [27.6%], and overweight/obesity [16.5%]) and 41.6% had multiple (≥ 2) CVD risk factors. A positive family history of at least one CVD risk factor in a first-degree relative was reported in 54.1% of the cohort. Predictors of elevated TC: family history of CVD (β[SE] = 23.1[8.3], P = 0.006); of elevated LDL-c: baseline diastolic blood pressure (DBP) (β[SE] = 11.4[4.7], P = 0.003) and family history of CVD (β[SE] = 20.7[6.8], P = 0.017); of elevated TGs: baseline DBP (β[SE] = 23.8[9.1], P = 0.010) and family history of CVD (β[SE] = 31.0[13.1], P = 0.020); and of low HDL-c levels: baseline DBP (β[SE] = 4.8[2.1], P = 0.022]).

CONCLUSION

Our findings suggest that elevated lipid profiles are associated with DBP and a positive family history of CVD. It is of utmost importance to prevent and control modifiable risk factors such as these, as early as childhood, given that inadequate glycemic control and elevation in blood pressure intensify the risk of dyslipidemia.

Keywords: Type 1 diabetes; Children and adolescents; Cardiovascular disease risk factors; Dyslipidemia; Hypertension; Family history of cardiovascular disease risk factors

Core Tip: Co-occurrence of type 1 diabetes (T1D) and cardiovascular disease (CVD) risk factor clustering (overweight/obesity, hypertension, family history of CVD and dyslipidemia) may contribute to early-onset CVD. Our findings demonstrated that most T1D patients already had at least one CVD risk factor during childhood, with dyslipidemia being the most prevalent. It is noteworthy that clustering of CVD risk factors was observed in approximately one-half of the cohort and that there was a positive family history of at least one CVD risk factor in more than 50% of the patients. The number and distribution of CVD risk factors were similar for males and females.