Statins Improve Carotid IMT in Teens With Type 1 Diabetes

LOS ANGELES — Treating adolescents with type 1 diabetes with statins early in the course of their disease may lead to measurable improvement in their carotid intima-media thickness, an important risk factor for stroke and heart disease, preliminary data showed.

A pilot study of 26 adolescents with type 1 diabetes found that those randomized to receive simvastatin (Zocor) for a year demonstrated a regression from baseline of the progression of carotid intima-media thickness (IMT), while those receiving a placebo had continued worsening of their IMT, Dr. Francine R. Kaufman reported at the annual meeting of the Society of Adolescent Medicine.

Measurements by two-dimensional ultrasound of the IMT of the carotid artery is an indirect but useful way to assess the presence and progression of atherosclerosis, Dr. Kaufman explained in her presentation during the meeting's “Hot Topics” session.

An earlier, long-term study of carotid IMT in 115 adolescents with diabetes and 87 controls was conducted at Children's Hospital Los Angeles, where Dr. Kaufman heads the center for diabetes, endocrinology, and metabolism and is director of the comprehensive childhood diabetes center.

In that study, investigators found that adolescents (aged 12–21 years) with diabetes had significantly thicker IMT measurements than controls, and that there was an association between higher IMT and elevated levels of LDL cholesterol, apolipoprotein B, and lysophosphatidic acid (J. Pediatrics 2004;145:452–7). The current study explored whether early treatment of type 1 diabetes with statins might have an impact on carotid IMT.

Adolescents assigned to receive statins or placebo were similar in age (15–16 years), baseline HbA1c values (8.4%–8.5%), and baseline IMT (mean 0.5510–0.5656 mm); 30% were males and 70% were females. Mean LDL cholesterol levels were slightly lower in the placebo group (133 mg/dL), compared with adolescents who received a statin (147 mg/dL).

After a year, IMT had increased in the control group by a mean 0.0065 mm, while it regressed among statin takers by −0.0156 mm, reported Dr. Kaufman, professor of pediatrics at the University of Southern California, Los Angeles.

Dr. Kaufman said that the American Diabetes Association, American Academy of Pediatrics, and American Heart Association all agree that children with type 1 diabetes should be screened for dyslipidemia.

How to manage dyslipidemia in adolescents with type 1 diabetes is still an unanswered question, she said.

“Most people suggest that we should start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range,” she said.

Dr. Kaufman said she has had no relevant financial relationships with pharmaceutical companies in the past 12 months.

After a year, IMT had increased in the control group by 0.0065 mm, while it regressed in statin takers by −0.0156 mm. DR. KAUFMAN

LOS ANGELES — Treating adolescents with type 1 diabetes with statins early in the course of their disease may lead to measurable improvement in their carotid intima-media thickness, an important risk factor for stroke and heart disease, preliminary data showed.

A pilot study of 26 adolescents with type 1 diabetes found that those randomized to receive simvastatin (Zocor) for a year demonstrated a regression from baseline of the progression of carotid intima-media thickness (IMT), while those receiving a placebo had continued worsening of their IMT, Dr. Francine R. Kaufman reported at the annual meeting of the Society of Adolescent Medicine.

Measurements by two-dimensional ultrasound of the IMT of the carotid artery is an indirect but useful way to assess the presence and progression of atherosclerosis, Dr. Kaufman explained in her presentation during the meeting's “Hot Topics” session.

An earlier, long-term study of carotid IMT in 115 adolescents with diabetes and 87 controls was conducted at Children's Hospital Los Angeles, where Dr. Kaufman heads the center for diabetes, endocrinology, and metabolism and is director of the comprehensive childhood diabetes center.

In that study, investigators found that adolescents (aged 12–21 years) with diabetes had significantly thicker IMT measurements than controls, and that there was an association between higher IMT and elevated levels of LDL cholesterol, apolipoprotein B, and lysophosphatidic acid (J. Pediatrics 2004;145:452–7). The current study explored whether early treatment of type 1 diabetes with statins might have an impact on carotid IMT.

Adolescents assigned to receive statins or placebo were similar in age (15–16 years), baseline HbA1c values (8.4%–8.5%), and baseline IMT (mean 0.5510–0.5656 mm); 30% were males and 70% were females. Mean LDL cholesterol levels were slightly lower in the placebo group (133 mg/dL), compared with adolescents who received a statin (147 mg/dL).

After a year, IMT had increased in the control group by a mean 0.0065 mm, while it regressed among statin takers by −0.0156 mm, reported Dr. Kaufman, professor of pediatrics at the University of Southern California, Los Angeles.

Dr. Kaufman said that the American Diabetes Association, American Academy of Pediatrics, and American Heart Association all agree that children with type 1 diabetes should be screened for dyslipidemia.

How to manage dyslipidemia in adolescents with type 1 diabetes is still an unanswered question, she said.

“Most people suggest that we should start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range,” she said.

Dr. Kaufman said she has had no relevant financial relationships with pharmaceutical companies in the past 12 months.

After a year, IMT had increased in the control group by 0.0065 mm, while it regressed in statin takers by −0.0156 mm. DR. KAUFMAN

LOS ANGELES — Treating adolescents with type 1 diabetes with statins early in the course of their disease may lead to measurable improvement in their carotid intima-media thickness, an important risk factor for stroke and heart disease, preliminary data showed.

A pilot study of 26 adolescents with type 1 diabetes found that those randomized to receive simvastatin (Zocor) for a year demonstrated a regression from baseline of the progression of carotid intima-media thickness (IMT), while those receiving a placebo had continued worsening of their IMT, Dr. Francine R. Kaufman reported at the annual meeting of the Society of Adolescent Medicine.

Measurements by two-dimensional ultrasound of the IMT of the carotid artery is an indirect but useful way to assess the presence and progression of atherosclerosis, Dr. Kaufman explained in her presentation during the meeting's “Hot Topics” session.

An earlier, long-term study of carotid IMT in 115 adolescents with diabetes and 87 controls was conducted at Children's Hospital Los Angeles, where Dr. Kaufman heads the center for diabetes, endocrinology, and metabolism and is director of the comprehensive childhood diabetes center.

In that study, investigators found that adolescents (aged 12–21 years) with diabetes had significantly thicker IMT measurements than controls, and that there was an association between higher IMT and elevated levels of LDL cholesterol, apolipoprotein B, and lysophosphatidic acid (J. Pediatrics 2004;145:452–7). The current study explored whether early treatment of type 1 diabetes with statins might have an impact on carotid IMT.

Adolescents assigned to receive statins or placebo were similar in age (15–16 years), baseline HbA1c values (8.4%–8.5%), and baseline IMT (mean 0.5510–0.5656 mm); 30% were males and 70% were females. Mean LDL cholesterol levels were slightly lower in the placebo group (133 mg/dL), compared with adolescents who received a statin (147 mg/dL).

After a year, IMT had increased in the control group by a mean 0.0065 mm, while it regressed among statin takers by −0.0156 mm, reported Dr. Kaufman, professor of pediatrics at the University of Southern California, Los Angeles.

Dr. Kaufman said that the American Diabetes Association, American Academy of Pediatrics, and American Heart Association all agree that children with type 1 diabetes should be screened for dyslipidemia.

How to manage dyslipidemia in adolescents with type 1 diabetes is still an unanswered question, she said.

“Most people suggest that we should start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range,” she said.

Dr. Kaufman said she has had no relevant financial relationships with pharmaceutical companies in the past 12 months.

After a year, IMT had increased in the control group by 0.0065 mm, while it regressed in statin takers by −0.0156 mm. DR. KAUFMAN