Air Pollution, Subclinical CVD and Inflammatory Markers in the SEARCH Cohort

描述(申请人提供)：1型糖尿病是儿童和青年中的主要慢性病之一，其影响在全球范围内不断增加。加强对糖尿病病情和任何现有心血管疾病(CVD)危险因素的医疗和营养管理是目前的关键治疗方法。然而，即使在严格遵守这些方案的情况下，儿童时期糖尿病的发病也使这一人群面临显著增加的心血管疾病发病率和死亡率的长期风险。研究表明，与非糖尿病患者相比，患有糖尿病的成年人更容易因暴露在室外空气污染中而增加心血管疾病的发病率和死亡率。在这一领域进行的研究很少，以检查患有糖尿病的儿童和青少年是否同样容易受到影响；然而，鉴于儿童通常在户外呆的时间更长，对环境暴露更敏感，这一推论似乎是合理的。由于1型糖尿病的早期发病增加了成年后心血管疾病的风险，因此迫切需要了解空气污染暴露在这一人群中的作用。随着美国不同种族和民族的代表以及地理上不同的地区的代表，以及关于心血管疾病风险因素的广泛现有信息的可获得性，青年糖尿病研究(SEARE)提供了一个前所未有的机会，可以有效地系统地研究空气污染对心血管风险的短期和长期影响。在这一青年高危人群中，我们将研究空气污染暴露对炎症标志物和心血管功能指标的急性影响，以及这些暴露对心血管结构的慢性影响。了解空气污染对1型糖尿病儿童和青少年的炎症和亚临床心血管疾病的作用可能会对治疗方法和行为建议产生重大影响。

DESCRIPTION (provided by applicant): Type 1 diabetes mellitus is one of the leading chronic conditions among children and youth and its impact is increasing worldwide. Intense medical and nutritional management of the diabetic condition and any existing cardiovascular disease (CVD) risk factors is currently the key treatment approach. Yet even under rigorous adherence to these regimens, the onset of diabetes in childhood places this population at significantly increased long term risks of CVD morbidity and mortality. Research has shown that adults with diabetes are more susceptible than nondiabetics for increased CVD morbidity and mortality associated with exposures to outdoor air pollution. Very little research in this area has been conducted to examine whether children and youth with diabetes are similarly susceptible; however the inference seems reasonable, given that children typically spend more time outside and are more sensitive to environmental exposures. Since the early onset of type 1 diabetes increases CVD risks in adulthood, there is an urgent need to understand the role of air pollution exposures in this population. With representation of diverse racial and ethnic groups and geographically distinct areas of the US, as well as the availability of extensive, existing information on CVD risk factors, the SEARCH for Diabetes in Youth Study (SEARCH) offers an unprecedented opportunity to systematically study, in an efficient manner, the short and long-term effects of air pollution on cardiovascular risk. In this high-risk population of youth, we will examine the acute effects of air pollution exposures on inflammatory markers and measures of cardiovascular function, as well as the chronic effects of these exposures on cardiovascular structure. Understanding the role of air pollution on inflammation and subclinical CVD among children and youth with type 1 diabetes could have a major impact on treatment approaches and behavioral recommendations.