Predictors of Arterial Stiffness in Adolescents and Adults with Type 1 Diabetes: A Cross-Sectional Study

ABSTRACT Introduction Individuals with type 1 diabetes have increased arterial stiffness compared to age-matched healthy controls. Our aim was to determine which hemodynamic and demographic factors predict arterial stiffness in this population. Research Design and Methods Carotid-femoral pulse wave velocity (cfPWV) was examined in 41 young adults and adolescents with type 1 diabetes without microvascular complications. Two ordinary least squares regression analyses were performed to determine multivariate relationships between cfPWV [log e ] and: 1) age, duration of diabetes, sex, and HbA1c, and 2) augmentation index (AIx), mean arterial pressure, flow-mediated dilation (FMD), and heart rate. We also examined differences in macrovascular outcome measures between sexes. Results Age, sex, and FMD provided unique predictive information about cfPWV in these participants with type 1 diabetes. Despite having similar cardiovascular risk factors, males had higher cfPWV compared to females but no differences were observed in other macrovascular outcomes (including FMD and AIx). Conclusions Only age, sex, and FMD were uniquely associated with arterial stiffness in adolescents and adults with uncomplicated type 1 diabetes. Females had less arterial stiffness and similar nitric-oxide dependent endothelial function compared to males. Larger, prospective investigation is warranted to determine the temporal order of and sex-differences in arterial dysfunction in type 1 diabetes. Significance of this study What is already known about this subject? A measure of central artery stiffness, carotid-femoral pulse wave velocity (cfPWV) predicts renal outcomes, cardiovascular events, and mortality in persons with type 1 diabetes. Age, race, mean arterial pressure, waist-to-height ratio/body mass index, presence of microalbuminuria have all been uniquely associated with cfPWV in populations with type 1 diabetes. The relationship between cfPWV and flow mediated dilation (FMD), a measure of nitric oxide dependent endothelial function at the brachial artery, has not been defined in type 1 diabetes, and the relationship between diabetes duration and these vascular measures are unclear. What are the new findings? Arterial stiffness and NO-dependent endothelial dysfunction were highly prevalent even within 5 years of diabetes diagnosis (16.7% and 83.3% respectively) in this cohort of adolescents and adults with uncomplicated type 1 diabetes. FMD was uniquely associated with cfPWV. Augmentation index (AIx), mean arterial pressure, and diabetes duration were not predictive of cfPWV. Despite a greater excess cardiovascular risk associated with type 1 diabetes in females compared to males, macrovascular function was no worse in females when examining sex differences. Females had a lower cfPWV and similar AIx and FMD compared to males. How might these results change the focus of research or clinical practice? Larger, prospective clinical investigation is needed in type 1 diabetes to determine the temporal order of and sex-differences in arterial dysfunction.