Under-treatment of hypertension and hypercholesterolemia in children and adolescents with type 1 diabetes- Long term follow-up on time trends in the occurrence of cardiovascular disease, risk factors and medications use

Abstract

AIMS

1) To evaluate long-term trends in the occurrence and treatment of cardiovascular disease (CVD) risk factors and occurrence of CVD events in children with type 1 diabetes mellitus (T1DM), and 2) To assess determinants of under-treatment of CVD risk factors.

METHODS

A retrospective cohort study was conducted in 3,728 children (<19 years) with T1DM and up to 5 age and gender-matched diabetes-free children (reference cohort) (n=18,513) using data from the Clinical Practice Research Datalink (CPRD).

RESULTS

Children with T1DM compared with diabetes-free subjects had significantly higher annual prevalence rates of CVD risk factors and cardiovascular (CV) medication use 20 years after the onset of diabetes (index date); hypertension: 35.2% vs. 11.4%, p<0.001, hypercholesterolemia: 66.7% vs. 7.14%, p<0.001 and CV medication use: 37.0% vs. 3.6%, p<0.001, respectively. The significant differences between prevalence rates in the two cohorts already started one year before the index date. Furthermore, 50% of the children in the T1DM cohort with hypertension and 53% with hypercholesterolemia remained untreated with CV drugs for a period of 2-5 years during the 20-year follow-up. Age was the only determinant associated with undertreated hypertension in the T1DM cohort.

CONCLUSIONS

Children with T1DM had substantial higher prevalence rates of hypertension and hypercholesterolemia one year before up to 20 years after the onset of diabetes compared to non-diabetics. There is a substantial under-treatment of CVD risk factors with CV drugs. Screening for CVD risk factors in children with T1DM and adequate treatment is of utmost importance to prevent CVD later in life.

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