Early Markers of Atherosclerosis in Children and Adolescents with Type 1 Diabetes Mellitus

Evaluation of salusin-β in paediatric patients with chronic kidney disease or hypertension

PURPOSE

Salusins are newly identified endogenous peptides implicated in the atherosclerotic process. Salusin-β, in particular, is recognized for its proatherogenic role. Given that atherosclerosis can commence in childhood, salusin-β holds promise as a potential biomarker for cardiovascular risk assessment. The objective of our study was to investigate salusin-β levels in children with early stages of chronic kidney disease (CKD) or hypertension (HTN), and compare them to healthy controls. Furthermore, we aimed to evaluate its association with obesity and pulse wave velocity (PWV), the latter being a well-established marker for determining arterial elasticity.

MATERIALS AND METHODS

This cross-sectional study involved 96 paediatric patients, including 46 with CKD and 50 with HTN, as well as 33 healthy controls. Anthropometric measurements, PWV assessments, serum salusin-β values, and basic laboratory investigations were conducted for all participants.

RESULTS

Salusin-β levels were found to be elevated in patients with CKD (p ​= ​0.014), but not in patients with HTN when compared to healthy controls. When correlating salusin-β levels with PWV, a significant but weak correlation was observed (r ​= ​0.211, p ​= ​0.020).

CONCLUSIONS

Salusin-β levels were elevated in paediatric patients with CKD. Additionally, salusin-β levels correlated significantly with PWV. Obesity played a smaller role in these correlations, with significant correlations observed only after combining cardiovascular risk factors revealing certain associations between salusin-β levels and some cardiovascular variables, but with inconclusive findings and, in some instances, even contrary to anticipated outcomes.

Causal associations between type 1 diabetes mellitus and cardiovascular diseases: a Mendelian randomization study

BACKGROUND

The presence of type 1 diabetes mellitus (T1DM) has been demonstrated to pose an increased risk for developing cardiovascular diseases (CVDs). However, the causal relationships between T1DM and CVDs remain unclear due to the uncontrolled confounding factors and reverse causation bias of the observational studies.

METHODS

Summary statistics of T1DM and seven CVDs from the largest available genome-wide association studies (GWAS) of European ancestry and FinnGen biobank were extracted for the primary MR analysis, and the analysis was replicated using UK biobank (UKBB) for validation. Three complementary methods: inverse variance weighted (IVW), weighted median, and MR-Egger were used for the MR estimates. The potential pleiotropic effects were assessed by MR-Egger intercept and MR-PRESSO global test. Additionally, multivariable MR (MVMR) analysis was performed to examine whether T1DM has independent effects on CVDs with adjustment of potential confounding factors. Moreover, a two-step MR approach was used to assess the potential mediating effects of these factors on the causal effects between T1DM and CVDs.

RESULTS

Causal effects of T1DM on peripheral atherosclerosis (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 1.02-1.10; p = 0.002)] and coronary atherosclerosis (OR = 1.03, 95% CI: 1.01-1.05; p = 0.001) were found. The results were less likely to be biased by the horizontal pleiotropic effects (both p values of MR-Egger intercept and MR-PRESSO Global test > 0.05). In the following MVMR analysis, we found the causal effects of T1DM on peripheral atherosclerosis and coronary atherosclerosis remain significant after adjusting for a series of potential confounding factors. Moreover, we found that hypertension partly mediated the causal effects of T1DM on peripheral atherosclerosis (proportion of mediation effect in total effect: 11.47%, 95% CI: 3.23-19.71%) and coronary atherosclerosis (16.84%, 95% CI: 5.35-28.33%). We didn't find significant causal relationships between T1DM and other CVDs, including heart failure (HF), coronary artery disease (CAD), atrial fibrillation (AF), myocardial infarction (MI) and stroke. For the reverse MR from CVD to T1DM, no significant causal relationships were identified.

CONCLUSION

This MR study provided evidence supporting the causal effect of T1DM on peripheral atherosclerosis and coronary atherosclerosis, with hypertension partly mediating this effect.