Los Angeles — Adolescents with type 1 diabetes who are treated with statins early in the course of their disease may have 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 children 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.
Two-dimensional ultrasound measurement of the IMT of the carotid artery is an indirect but useful way to assess the presence and progression of atherosclerosis, said Dr. Kaufman.
An earlier, long-term study of carotid IMT in 115 adolescent subjects 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. Investigators found that individuals aged 12-21 years with diabetes had significantly thicker IMT measurements than did 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 would affect carotid IMT. Adolescents assigned to receive statins or placebo were similar in age (15-16 years), baseline hemoglobin A1c values (8.4%-8.5%), and baseline IMT (mean 0.5510-0.5656 mm); 70% were females. Mean LDL cholesterol levels were lower in the placebo group (133 mg/dL), compared with the statin group (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.
The American Diabetes Association, American Academy of Pediatrics, and American Heart Association agree that children with type 1 diabetes should be screened for dyslipidemia, she said. The question is how to manage dyslipidemia in adolescents with type 1.
“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 conflicts of interest.
After a year, IMT increased in controls by a mean 0.0065 mm, but regressed in statin takers by 0.0156 mm.
Source DR. KAUFMAN