RISK FACTORS FOR ATHEROGENESIS IN TYPE 1 DIABETES

描述：本提案描述了基于人群的事件队列 旨在确定风险的年轻1型糖尿病患者研究 动脉粥样硬化性血管病变发生和早期发展的因素 疾病(ASVD)。1型糖尿病患者的风险要高得多 与普通人群相比，早产儿ASVD的发病率更高。的风险因素 ASVD的发展已被发现，但将它们与 动脉粥样硬化直到最近才变得可行。非侵入性研究进展 现在，成像可以及早检测到血管功能和 结构。这一成像提供了评估风险因素的机会 ASVD和血管状况在发育和发育的关键时期队列中的情况 ASVD的早期进展。这群人的参与非常好。科目 在1987-1992年间入选，并在糖尿病诊断后进行了随访。 实施了标准化的考试和面试方案 该数据库包括一个有价值的纵向血浆库。因为我们 已登记的事故案例，我们已从诊断收集信息 儿童、青少年和青壮年目前未出现 动脉硬化。我们建议扩展我们现有的数据库，以使用我们的 现有资源，包括我们的血浆库，并纳入有希望的新 和成熟的临床研究技术，通过：(I)测量血浆 储存的血浆和新采集的血液样本的血脂水平，(Ii) 测量新采集的血液样本中的甘油三酯水平，(Iii)测量 新收集的标本的尿白蛋白排泄率(已测量 从诊断到目前为止)，以及(Iv)通过臂部评估内皮功能 动脉超声，(V)测量动脉内膜中层厚度(IMT) 超声测量颈动脉，(Vi)计算机测量冠状动脉钙 断层扫描。这些活动将使我们能够实现以下目标 具体目标：1)确定已建立的风险之间的关系 动脉粥样硬化的因素与临床前疾病的发展 动脉粥样硬化，2)确定血管内皮细胞的关系 3)确定功能障碍与颈动脉IMT的关系 冠状动脉钙化与颈动脉内膜厚度。这样的信息在 进一步致力于动脉粥样硬化的一级预防 1型糖尿病患者。

DESCRIPTION: This proposal describes a population-based incident cohort study of young individuals with Type 1 diabetes designed to determine risk factors for the initiation and early progression of atherosclerotic vascular disease (ASVD). Individuals with Type 1 diabetes have substantially higher risk for premature ASVD than the general population. Risk factors for the development of ASVD have been identified, but linking them to initiation of atherosclerosis was not feasible until recently. Advances in non-invasive imaging now permit early detection of changes in blood vessel function and structure. This imaging provides an opportunity to evaluate risk factors for ASVD and vascular status in a cohort at a critical time for development and early progression of ASVD. Participation of the cohort is excellent. Subjects were enrolled from 1987-1992 and have been followed from diabetes diagnosis. Standardized protocols for examinations and interviews have been implemented and the data base includes a valuable longitudinal plasma bank. Because we enrolled incident cases, we have collected information from diagnosis on children, adolescents and young adults currently without symptoms of atherosclerosis. We propose to expand our existing database, to use our existing resources including our plasma bank, and to incorporate promising new and well established clinical research techniques by: (i) measuring plasma lipid levels on stored plasma and on newly collected blood samples, (ii) measuring triglyceride levels on newly collected blood samples, (iii) measuring urinary albumin excretion rates on newly collected specimens (already measured from diagnosis to date), and (iv) assessing endothelial function by brachial artery ultrasound, (v) measuring the intima medial thickness (IMT) of the carotid artery by ultrasound, and (vi) measuring coronary calcium by computed tomography scanning. These activities will allow us to pursue the following specific aims: 1) to determine the relationship between established risk factors for atherosclerosis and the development of pre-clinical atherosclerosis, 2) to determine the relationship between endothelial dysfunction and carotid IMT, and 3) to determine the relationship between coronary artery calcification and carotid IMT. Such information is critical in directing further efforts toward primary prevention of atherosclerosis in individuals with Type 1 diabetes mellitus.