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

描述（由申请人提供）：1型糖尿病是儿童和青少年的主要慢性疾病之一，其影响在全球范围内日益增加。加强医疗和营养管理糖尿病病情和任何现有的心血管疾病（CVD）危险因素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，儿童期糖尿病的发病使这一人群心血管疾病发病率和死亡率的长期风险显著增加。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于室外空气污染而增加心血管疾病的发病率和死亡率。在这一领域，很少有研究调查患有糖尿病的儿童和青少年是否同样容易患糖尿病；然而，考虑到孩子们通常花更多的时间在户外，对环境暴露更敏感，这个推论似乎是合理的。由于1型糖尿病的早期发病会增加成年期心血管疾病的风险，因此迫切需要了解空气污染暴露在这一人群中的作用。由于代表了美国不同的种族和民族群体以及地理上不同的地区，以及关于心血管疾病危险因素的广泛现有信息的可用性，青年糖尿病研究（SEARCH）提供了前所未有的机会，以有效的方式系统研究空气污染对心血管风险的短期和长期影响。在这一高危青年人群中，我们将研究空气污染暴露对炎症标志物和心血管功能测量的急性影响，以及这些暴露对心血管结构的慢性影响。了解空气污染对儿童和青少年1型糖尿病患者炎症和亚临床心血管疾病的作用可能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.