Cardiovascular health in adolescents with type 1 diabetes: The SEARCH CVD Stud

tion Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the US (1). People with type 1 diabetes are at increased risk of CVD compared with the general population (2). The incidence of type 1 diabetes worldwide is increasing (3), and prevention of CVD in this high risk population is a clinical and public health priority (4). With the growing recognition of a need to focus on the primordial prevention of CVD, the American Heart Association (AHA) published a definition for ideal cardiovascular health (ICH) metrics involving 7 modifiable health factors and behaviors (5). The ICH metrics included definitions of ideal, intermediate, and poor health for the following factors and behaviors: total cholesterol, blood pressure, fasting plasma glucose, smoking, body mass index (BMI), physical activity, and diet (5). Primordial prevention of risk factors to increase cardiovascular health is particularly relevant for childhood and adolescent populations (6). In the United States, fewer than 1% of adults meet the criteria for ICH in all 7 metrics (7-10). Studies in Finland (11,12) and from NHANES data in the US (13), found that no adolescents or young adults met the ICH criteria for all 7 metrics. In the Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) study, the number of ICH metrics was inversely associated with aortic intima-media thickness (aIMT) and directly associated with aortic elasticity (11). In the Cardiovascular Risk in Young Finns Study, the number of ICH metrics at the baseline visit was inversely associated with hypertension, metabolic syndrome, high low-density lipoprotein, and carotid artery intima-media thickness (cIMT) in adulthood (12). There have not been any published studies on the prevalence of ICH in a population of youth or adults with type 1 diabetes. It is of particular interest to evaluate whether the ICH metrics are associated with improved measures of subclinical cardiovascular structure and function before overt clinical disease appears. A limited amount of data exists on the association between ICH metrics and cardiovascular disease outcomes in adults (8,10,14), and only two reports (11,12) included subclinical cardiovascular disease outcomes. Given the higher risk of CVD seen in those with type 1 diabetes, and the importance of establishing Alman et al. Page 2 Pediatr Diabetes. Author manuscript; available in PMC 2015 November 01