LDL, Blood Pressure in T1D Differ From Background Levels

The study covered in this summary was published on Research Square as a preprint and has not yet been peer reviewed.

Key Takeaways

• Among adults with type 1 diabetes, average low-density lipoprotein (LDL)-cholesterol and total cholesterol levels were reduced and average blood pressure values were higher compared with those of age-matched people in the general population in almost all age categories.

• These relationships remained roughly consistent regardless of lipid-lowering or antihypertensive medication use in a cross-sectional study of people residing in the Netherlands.

• Despite wider use of cardioprotective medications by adults with type 1 diabetes compared with the general population, the prevalence of cardiovascular disease (CVD) was about twofold to fourfold higher among the people with type 1 diabetes.

Why This Matters

• Adults with type 1 diabetes undergo treatment for high LDL-cholesterol levels to a lesser extent compared with the general population, but the opposite was true with regard to blood pressure readings.

• Differences between those with type 1 diabetes and the background population in mean blood pressure levels across the various age strata appeared larger for women, suggesting possible sex-based differences in the management of LDL-cholesterol and blood pressure. The findings suggest that women with type 1 diabetes were not receiving optimal antihypertensive treatment compared to men. This is important because women with type 1 diabetes have a higher risk of vascular events than men.

• Results from previous studies documented accelerated vascular aging and increased arterial stiffness in youth and young adults with type 1 diabetes, effects that might help explain the increases in systolic blood pressure seen in people with type 1 diabetes in most age strata in the current study.

• Little is known about lipid profiles and blood pressure across age groups for people with type 1 diabetes. Comparing the lipid levels and blood pressures of individuals with type 1 diabetes to those of a background population can help benchmark differences between these two populations. These findings may also provide insights about the optimal time to start pharmacologic interventions.

Study Design

• The researchers performed a cross-sectional study to compare lipid levels and blood pressure values in adults with type 1 diabetes with those of age-matched people in the general population.

• They compared data collected during 2018 from 2178 adults with type 1 diabetes seen at any of six outpatient clinics in the Netherlands with data from 146,822 age-matched adults living in the Netherlands who did not have diabetes and were enrolled in the Lifelines cohort study from 2007 to 2014.

• The data included age, sex, ethnicity, body mass index (BMI), smoking behavior, blood pressure, total and LDL-cholesterol, lipid-lowering medication use, antihypertensive medication use, and the presence of CVD. Some analyses stratified patients into any one of six sequential age strata.

Key Results

• Compared with the general population, adults with type 1 diabetes were younger (27 vs 44), had comparable BMI, had higher average blood pressure (131/76 mm Hg compared with 125/74 mm Hg), had lower total and LDL-cholesterol (2.67 mmol/L compared with 3.23 mmol/L), and were less often current smokers but more often had a medical history of cardiovascular disease and used more lipid-lowering and antihypertensive medications.

• Among people not using a lipid-lowering medication, total and LDL-cholesterol levels gradually increased with age in the background population, but in those with type 1 diabetes, these levels remained relatively stable with increasing age. Among the patients taking lipid-lowering medication, LDL- and total-cholesterol levels decreased in the older age groups, and the differences between the subgroups with and those without type 1 diabetes also decreased.

• Systolic blood pressure (SBP) increased with aging. People with type 1 diabetes showed more variation in SBP. Diastolic blood pressure was higher in the younger age groups with type 1 diabetes (up to 50 years old), but this difference disappeared with older people.

• The difference in blood pressure between people with type 1 diabetes compared with the general population was greater in women than in men.

• For women with type 1 diabetes, mean SBP was up to 8 mm Hg higher than for women of the same age in the general population. SBP in women using antihypertensive medication was much higher than in men.

• The prevalence of CVD was higher among those with type 1 diabetes except for those younger than 30 years. The disparity in CVD prevalence was greatest among those aged 40–50 years, with a 5.97 ratio between the background and the diabetes populations.

Limitations

• Individuals at the extremes of lipid profiles and blood pressure measurements may be underrepresented in this real-world study, which could result in an underestimation of lipid and blood pressure values.

• The data came from electronic medical records, which can be missing data, but data were missing from only 4 % of the individuals with type 1 diabetes.

• Measurement of blood pressure in outpatient clinics may have overestimated actual blood pressures.

• Total and LDL-cholesterol levels came from blood specimens from a mix of fasting and nonfasting participants.

Disclosures

This is a summary of a preprint research study, “Differences in Lipid and Blood Pressure Measurements Between Individuals With Type 1 Diabetes and the General Population,” written by researchers from the University of Groningen, the Netherlands, and from the Diabeter organization, published on Research Square, and provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on research square.com.

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