Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy.
International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, University of Milan, 20157 Milan, Italy.
Int J Mol Sci. 2020 Jul 12;21(14):4928. doi: 10.3390/ijms21144928.
The prevalence of diabetes mellitus is rising among children and adolescents worldwide. Cardiovascular diseases are the main cause of morbidity and mortality in diabetic patients. We review the impact of diabetes on establishing, during childhood and adolescence, the premises for cardiovascular diseases later in life. Interestingly, it seems that hyperglycemia is not the only factor that establishes an increased cardiovascular risk in adolescence. Other factors have been recognized to play a role in triggering the onset of latent cardiovascular diseases in the pediatric population. Among these cardiovascular risk factors, some are modifiable: glucose variability, hypoglycemia, obesity, insulin resistance, waist circumference, hypertension, dyslipidemia, smoking alcohol, microalbuminuria and smoking. Others are unmodifiable, such as diabetes duration and family history. Among the etiological factors, subclinical endothelial dysfunction represents one of the earliest key players of atherosclerosis and it can be detected during early ages in patients with diabetes. A better assessment of cardiovascular risk in pediatric population still represents a challenge for clinicians, and thus further efforts are required to properly identify and treat pediatric patients who may suffer from cardiovascular disease later in early adulthood.
糖尿病在全球范围内的儿童和青少年中的患病率正在上升。心血管疾病是糖尿病患者发病率和死亡率的主要原因。我们回顾了糖尿病对儿童和青少年时期心血管疾病发生的潜在风险的影响。有趣的是，高血糖似乎不是导致青少年心血管风险增加的唯一因素。其他因素已被认为在小儿人群中引发潜在心血管疾病的发病中发挥作用。在这些心血管危险因素中，有些是可以改变的：血糖变异性、低血糖、肥胖、胰岛素抵抗、腰围、高血压、血脂异常、吸烟、饮酒、微量白蛋白尿和吸烟。其他则是不可改变的，如糖尿病病程和家族史。在病因学因素中，亚临床内皮功能障碍是动脉粥样硬化的最早关键因素之一，在糖尿病患者的早期就可以检测到。更好地评估儿科人群的心血管风险仍然是临床医生面临的挑战，因此需要进一步努力，以正确识别和治疗可能在成年早期患心血管疾病的儿科患者。
