Cardiovascular Implications of Type 1 Diabetes

Diabetes is a disease whose primary characteristic implies that the body is unable to control blood sugar levels due to insufficient amounts of hormone insulin or increased insulin resistance. High levels of blood sugar can lead to a number of life-threatening conditions such as cardiovascular disease. The prevalence of diabetes has steadily increased throughout the world and it is estimated that around one in every eleven people suffer from diabetes. Extrapolations suggest that by 2040 there will be 642 million people with diabetes, which will be a major health concern across the globe. Patients who are not able to produce insulin are considered to have Type 1 diabetes, which usually occurs in infancy and requires regular insulin injections to maintain blood glucose levels within the normal range. Type 1 diabetes, in particular, is associated with an increased risk of cardiovascular disease.

Despite ongoing research, the basic mechanism linking diabetes mellitus with high cardiovascular risk is not yet clearly determined. However, it is known that lipid-lowering therapy reduces the risk of cardiovascular disease in patients with type 1 diabetes by about one-fifth. Lipoproteins and cardiovascular risk Lipoproteins are the means by which triglycerides and cholesterol are transported to the body. There are several types of lipoproteins, characterized by the types of surface proteins, the apoplipoproteins they carry. Associated apolipoprotein also determines lipoprotein function because it acts as a substrate for membrane-specific receptors.

The most dense lipoprotein, high density lipoprotein (HDL) is usually considered to be cardioprotective because it removes cholesterol from the blood and transports it to the liver to be metabolized. This function is a consequence of HDL showing apolipoprotein A1, which allows HDL to be internalized by the liver. However, it was observed that 40% of men suffering from heart disease had healthy levels of HDL, and very high levels of HDL were linked to an increased risk of major coronary events. Further investigations of HDL have shown that it can also become complexed with C3 apolipoprotein having the opposite function. Apolipoprotein C3 prevents lipoprotein absorption and destruction by the liver.

In addition, it has been shown that because HDL which exhibits apolipoprotein A1 to return excess triglycerides and cholesterol to the liver, apolipoprotein A1 must undergo a significant change. Thus, it appears that high HDL levels per se do not necessarily indicate a low risk of developing stroke or heart disease. To determine the level of ateroprotection offered by HDL, the HDL function must be set. Proportions of active A1 HDL apolipoprotein can be measured using electronic paramagnetic resonance (EPR) or fluorescence spectroscopy. Effects of Diabetes on HDL In a continuous search for the relationship between Type 1 diabetes and increased risk of cardiovascular disease, a research was conducted that assessed the HDL function in children and young adults with type 1 diabetes.

The proportion of active HDL apolipoprotein was evaluated in 293 patients with type 1 diabetes (mean age 13. 7 years) and 111 healthy control subjects at baseline and again after 5 years. Lipoproteins extracted from blood samples were analyzed by EPR using a Bruker BioSpin eScan EPR spectrometer. The proportion of active HDL apolipoprotein was significantly lower in the diabetic group compared to the control group and remained relatively constant from baseline to 5 years. The conclusion of the research was that Type 1 diabetes leads to a decrease in the cardiovascular protection function of HDL.

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