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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EChildren with diabetes are at high risk for premature cardiovascular disease (CVD), which can lead to mortality later in life. Screening and treatment of modifiable risk factors in young patients with diabetes are important to decrease lifetime risk for CVD. This article discusses several noninvasive surrogate measures that would allow for the stratification of CVD risk, and he presented evidence for more aggressive treatment of patients at the highest risk for macrovascular disease in adulthood.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EChildren with diabetes are at high risk for premature cardiovascular disease (CVD), which can lead to mortality later in life. Screening and treatment of modifiable risk factors in young patients with diabetes are important to decrease lifetime risk for CVD. R. Paul Wadwa, MD, University of Colorado School of Medicine, Aurora, Colorado, USA, discussed several noninvasive surrogate measures that would allow for the stratification of CVD risk, and he presented evidence for more aggressive treatment of patients at the highest risk for macrovascular disease in adulthood.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EEndothelial dysfunction is considered an early stage in the pathogenesis of atherosclerosis. Evidence indicates that endothelial dysfunction in children with diabetes may predispose them to the development of early atherosclerosis [J\u00e4rvisalo MJ et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2004]. The brachial ultrasound technique can be beneficial for detecting impaired flow-mediated dilation. Another tool for measuring endothelial dysfunction is peripheral arterial tonometry. In one study, children with type 1 diabetes had endothelial dysfunction, as evidenced by lower mean reactive hyperemia peripheral artery tonometry scores when compared with children without diabetes [Haller M et al. \u003Cem\u003EPediatr Diabetes\u003C\/em\u003E 2007].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ENoninvasive B-mode ultrasonographic measurement of progression of intima-media thickness in the distal common carotid artery is a useful surrogate endpoint for clinical coronary events. Increases in the thickness of the intima and media of the carotid artery are directly associated with an increased risk of myocardial infarction and stroke in older adults without a history of CVD [O\u0027Leary DH et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 1999]. Although data are limited in younger patients, one study has shown an increase in carotid intima-media thickness (cIMT) and a decrease in flow-mediated dilation in children (mean age 11 years) with type 1 diabetes (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [J\u00e4rvisalo MJ et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2004]. Preliminary data presented at the 2011 meeting of the American Diabetes Association indicate significantly thicker cIMT in the common and internal carotid in youth with type 1 diabetes compared with controls [Urbina EM et al. \u003Cem\u003EDiabetes\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/32\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022cIMT in Controls and Type 1 Diabetes.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-149850613\u0022 data-figure-caption=\u0022cIMT in Controls and Type 1 Diabetes.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/32\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/32\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/32\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12751\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EcIMT in Controls and Type 1 Diabetes.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from P Wadwa, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EIn an ancillary study to the SEARCH for Diabetes in Youth study, the measurement of arterial stiffness by pulse-wave velocity, pulse-wave analysis, and brachial artery distensibility indicated that youths with type 2 diabetes had worse arterial stiffness than youths with type 1 diabetes [Wadwa RP et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2010]. Further, pulse-wave velocity was higher than controls in youths with type 1 diabetes with a mean age of 19 years but not in youths with a mean age of 15 years, suggesting that the right time for aggressive intervention to prevent vascular damage would be between the ages of 15 to 19 years [Wadwa RP et al. \u003Cem\u003EDiabetes\u003C\/em\u003E 2011 (two ADA abstracts)].\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ECoronary artery calcification correlates with overall coronary plaque burden and can be predictive of future coronary events. Although data in adults with diabetes are strong, coronary artery calcification may be of lesser interest in pediatric patients, as there is a relatively low presence of coronary artery calcification in patients aged \u0026lt;30 years [Starkman HS. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2003].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EEchocardiography has been used to document cardiac dysfunction in adults with diabetes. Recent studies have shown that it can detect diastolic dysfunction, increased ventricular septal thickness, and lower circumferential strain compared with nondiabetic controls [Nadeau K et al. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 2010; Salem et al. \u003Cem\u003EPediatr Diabetes\u003C\/em\u003E 2009]. Further work is needed to evaluate risk factors associated with changes in cardiac structure and function.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EMost of these techniques are affordable, available, and safe. Currently, however, they are used in clinical research only. Further work is needed to standardize techniques and the development of normative data that account for changes with age and pubertal development. The results need to be reproducible, and their use should be cost-effective and lead to effective treatment\/interventions.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/10\/32.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznffp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznffp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}