Experimental and Clinical Endocrinology & Diabetes, Inhaltsverzeichnis

Exp Clin Endocrinol Diabetes 2016; 124(05): 283-287
DOI: 10.1055/s-0042-101243

Article

© Georg Thieme Verlag KG Stuttgart · New York

Arterial Stiffness, BMI, Dipping Status and ACE D/I Polymorphism in Type 1 Diabetic Children

I. Pietrzak

¹Department of Pediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Łódź, Poland

,

W. Fendler

²Medical University of Lodz, Łódź, Poland

,

I. Dróżdż

²Medical University of Lodz, Łódź, Poland

,

B. Mianowska

²Medical University of Lodz, Łódź, Poland

,

W. Młynarski

²Medical University of Lodz, Łódź, Poland

,

A. Szadkowska

²Medical University of Lodz, Łódź, Poland

› Institutsangaben

Abstract

The aim: of the study was to investigate clinical and genetic determinants of arterial stiffness in children and adolescents with type 1 diabetes mellitus.

Material and Methods: 122 patients (mean age: 16.0±2.35 years), with an average diabetes duration of 5.0 years and without evidence of arterial hypertension were recruited. Ambulatory arterial stiffness index (AASI) was assessed with 24-h automatic blood pressure monitoring. Body weight, height, HbA1c and plasma lipids were measured. Angiotensin I converting enzyme (ACE) gene insertion (I)/deletion (D) polymorphism was analysed.

Results: Mean AASI equalled 0.22±0.20 and showed significant, positive correlation with age and BMI-SDS. No association was found between AASI and gender, diabetes duration, daily insulin dose, HbA_1c and blood lipids concentration. AASI was higher in non-dippers compared to dippers (0.26±0.18 vs. 0.19±0.18, respectively; p=0.04). In a multivariate model AASI was significantly associated with II homozygosity of ACE gene (p=0.007).

Conclusions: In type 1 diabetic children and adolescents AASI is correlated with age and BMI-SDS. Non-dipping status and I-allele were associated with higher arterial stiffness.

Key words

Key words

diabetes - cardiovascular risk management - obesity

References
1 Soedamah-Muthu SS, Fuller JH, Mulnier HE et al. High risk of cardiovascular disease in patients with type 1 diabetes in the U.K.: a cohort study using the general practice research database. Diabetes Care 2006; 29: 798-804
2 Bruzzi P, Predieri B, Patianna VD et al. Longitudinal evaluation of endothelial function in children and adolescents with type 1 diabetes mellitus: A long-term follow-up study. Pediatr Int 2014; 56: 188-195
3 Göksen D, Levent E, Kar S et al. Serum adiponectin and hsCRP levels and non-invasive radiological methods in the early diagnosis of cardiovascular system complications in children and adolescents with type 1 diabetes mellitus. J Clin Res Pediatr Endocrinol 2013; 5: 174-181
4 Çiftel M, Ertuğ H, Parlak M et al. Investigation of endothelial dysfunction and arterial stiffness in children with type 1 diabetes mellitus and the association with diastolic dysfunction. Diab Vasc Dis Res 2014; 11: 19-25
5 Urbina ED, Wadwa RP, Davis C et al. Prevalence of increased arterial stiffness in children with type 1 diabetes mellitus differs by measurement site and sex: The SEARCH for Diabetes in Youth Study. J Pediatr 2010; 156: 731-737
6 Li Y, Wang JG, Dolan E et al. Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension 2006; 47: 359-364
7 Adiyaman A, Dechering DG, Boggia J et al. International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes Investigators. Determinants of the ambulatory arterial stiffness index in 7604 subjects from 6 populations. Hypertension 2008; 52: 1038-1044
8 Palmas W, Pickering TG, Teresi J et al. Ambulatory blood pressure monitoring and all-cause mortality in elderly people with diabetes mellitus. Hypertension 2009; 53: 120-127
9 Simonetti GD, VON Vigier RO, Wühl E et al. Ambulatory arterial stiffness index is increased in hypertensive childhood disease. Pediatric Research 2008; 64: 303-307
10 Šulaková T, Janda J, Černá J et al. Assessment of arterial stiffness from ambulatory blood pressure monitoring in children with diabetes mellitus type 1 (DMT1). J Hum Hypert 2012; 26: 357-364
11 Kraja AT, Chasman DI, North KE et al. Pleiotropic genes for metabolic syndrome and inflammation. Mol Genet Metab 2014; 112: 317-338
12 Li D, Singh RM, Liu L et al. Oxidized-LDL through LOX-1 increases the expression of angiotensin converting enzyme in human coronary artery endothelial cells. Cardiovasc Res 2003; 57: 238-243
13 Fatini C, Sticchi E, Sofi F et al. Multilocus analysis in candidate genes ACE, AGT, and AGTR1 and predisposition to peripheral arterial disease: role of ACE D/-240T haplotype. J Vasc Surg 2009; 50: 1399-1404
14 Guney AI, Ergec D, Kirac D et al. Effects of ACE polymorphisms and other risk factors on the severity of coronary artery disease. Genet Mol Res 2013; 12: 6895-6906
15 Taniwaki H, Kawagishi T, Emoto M et al. Association of ACE gene polymorphism with arterial stiffness in patients with type 2 diabetes. Diabetes Care 1999; 22: 1858-1864
16 Jones SC, Bilous M, Winship S et al. Validation of the OSCAR 2 oscillometric 24-hour ambulatory blood pressure monitor according to the International Protocol for the validation of blood pressure measuring devices. Blood Press Monit 2004; 9: 219-223
17 Flynn JT, Daniels SR, Hayman LL et al. Update: Ambulatory Blood Pressure Monitoring in Children and Adolescents: A Scientific Statement From the American Heart Association. Hypertension 2014; 63: 1116-1135
18 Nawarycz T, Ostrowska-Nawarycz L. Wskaźnik masy ciała u dzieci i młodzieży łódzkiej w wieku szkolnym. Pol Merk Lek 2007; XXIII 136: 264-270
19 Rigat B, Hubert C, Corvol P et al. PCR detection of the insertion/deletion polymorphism of the human angiotensin converting enzyme gene (DCP1) (dipeptidyl carboxypeptidase 1). Nucleic Acids Res 1992; 20: 1433
20 Saner C, Simonetti GD, Wühl E et al. Increased ambulatory arterial stiffness index in obese children. Atherosclerosis 2015; 238: 185-189
21 Donald AE, Charakida M, Falaschetti E et al. Determinants of vascular phenotype in a large childhood population: the Avon Longitudinal Study of Parents and Children (ALSPAC). Eur Heart J 2010; 31: 1502-1510
22 Pandit D, Kinare A, Chiplonkar S et al. Carotid arterial stiffness in overweight and obese Indian children. J Pediatr Endocrinol Metab 2011; 24: 97-102
23 Aggoun Y, Farpour-Lambert NJ, Marchand LM et al. Impaired endothelial and smooth muscle functions and arterial stiffness appear before puberty in obese children and are associated with elevated ambulatory blood pressure. Eur Heart J 2008; 29: 792-799
24 Schiffrin EL. Vascular stiffening and arterial compliance. Implications for systolic blood pressure. Am J of Hypertens 2004; 17: 39S-48S
25 Wilkinson IB, Prasad K, Hall IR et al. Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll of Cardiol 2002; 39: 1005-1011
26 Leoncini G, Ratto E, Viazzi F et al. Metabolic syndrome and ambulatory arterial stiffness index in non-diabetic patients with primary hypertension. J of Hum Hypertens 2007; 21: 802-807
27 Strain WD, Chaturvedi N, Dockery F et al. Increased arterial stiffness in Europeans and African Caribbeans with type 2 diabetes cannot be accounted for by conventional cardiovascular risk factors. Am J of Hypertens 2006; 19: 889-896
28 Dolan E, Thijs L, Li Y et al. Ambulatory arterial stiffness index as a predictor of cardiovascular mortality in the Dublin Outcome Study. Hypertension 2006; 47: 365-370
29 Jerrard-Dunne P, Mahmud A, Feely J. Circadian blood pressure variation: relationship between dipper status and measures of arterial stiffness. J Hypertens 2007; 25: 1233-1239
30 Baumann M, Dan L, Nürnberger J et al. Association of ambulatory arterial stiffness index and brachial pulse pressure is restricted to dippers. J Hypertens 2008; 26: 210-214
31 Dabelea D, Talton JW, D’Agostino Jr R et al. Cardiovascular risk factors are associated with increased arterial stiffness in youth with type 1 diabetes: the SEARCH CVD study. Diabetes Care 2013; 36: 3938-3943
32 Steckelings UM, Rompe F, Kaschina E et al. The evolving story of the RAAS in hypertension, diabetes and CV disease: moving from macrovascular to microvascular targets. Fundam Clin Pharmacol 2009; 23: 693-703
33 Sie MP, Yazdanpanah M, Mattace-Raso FU et al. Genetic variation in the renin-angiotensin system and arterial stiffness. The Rotterdam Study. Clin Exp Hypertens 2009; 31: 389-399
34 Dima I, Vlachopoulos C, Alexopoulos N et al. Association of arterial stiffness with the angiotensin-converting enzyme gene polymorphism in healthy individuals. Am J Hypertension 2008; 21: 1354-1358
35 Tsai CT, Fallin D, Chiang FT et al. Angiotensinogen gene haplotype and hypertension: interaction with ACE gene I allele. Hypertension 2003; 41: 9-15
36 Benetos A, Gautier S, Ricard S et al. Influence of angiotensin-converting enzyme and angiotensin II type 1 receptor gene polymorphisms on aortic stiffness in normotensive and hypertensive patients. Circulation 1996; 94: 698-703
37 Rincon-Choles H, Kasinath BS, Gorin Y et al. Angiotensin II and growth factors in the pathogenesis of diabetic nephropathy. Kidney Int Suppl 2002; 82: S8-S11
38 Başar Y, Salmayenli N, Aksoy M et al. ACE gene polymorphism in peripheral vascular disease. Horm Metab Res 2007; 39: 534-537