Trends in CVD, Risk Factors, and Medications in Children With T1D

Children with type 1 diabetes (T1D) are at increased risk for hypertension and hypercholesterolemia both before and after the onset of diabetes, and there is substantial underuse of cardiovascular medications in this population, according to a retrospective cohort study published in the British Journal of Clinical Pharmacology.

Because there are a limited number of follow-up studies on the incidence and prevalence rates of cardiovascular disease risk factors and their treatment in the pediatric population with T1D, researchers reviewed data from the Clinical Practice Research Datalink in the United Kingdom. Information on 3728 children less than 19 years of age with T1D and at least 2 insulin prescriptions were evaluated along with data on 18,513 age- and gender-matched children without diabetes.

Compared with children without diabetes, children with T1D had significantly higher prevalence rates of hypertension (11.4% vs 35.2%, respectively; P <.001), hypercholesterolemia (7.14% vs 66.7%, respectively; P <.001), and cardiovascular medication use (3.6% vs 37.0%, respectively; P <.001) 20 years after the onset of diabetes. These differences started from one year before the onset of diabetes and further increased during the follow-up time.

Older children (15-18 years at diabetes onset) were more likely to have hypertension and hypercholesterolemia compared with younger children. In addition, substantial numbers of children with T1D and hypertension (50%) or hypercholesterolemia (53%) were undertreated for a period of 2 to 5 years during the 20-year follow-up. Age was the only factor associated with undertreated hypertension.

This was the first large population-based study designed to calculate long-term trends in prevalence and incidence rates of cardiovascular disease risk factors, events, and use of cardiovascular medications among children with T1D. “Screening for [cardiovascular disease ] risk factors in children with T1D [mellitus] and adequate treatment is of utmost importance to prevent [cardiovascular disease] later in life,” concluded the investigators.

Reference

Ahmadizar F, Souverein P, de Boer A, Maitland-van der Zee AH. Under-treatment of hypertension and hypercholesterolemia in children and adolescents with type 1 diabetes- Long term follow-up on time trends in the occurrence of cardiovascular disease, risk factors and medications use [published online December 7, 2017]. Br J Clin Pharmacol. doi: 10.1111/bcp.13482