EARLY PREDICTION OF SUBCLINICAL VASCULAR DAMAGE IN RISKY POPULATIONS

Background. Atherosclerosis is a progressive disease that starts during adoles-cence and exerts its negative effects later in life. High blood pressure is one of the principal risk factors for cardiovascular disease. Central blood pressure is the pressure that directly insists and other major arteries and is linked to target organ damage and cardiovascular events. The aim of the thesis was to assess the role of traditional and novel risk factors (central blood pressure, cBP) on children and adolescents with type I diabetes (T1D; study number 1) and in children and ado-lescents with solitary functional kidney (SFK; study n.2). Methods. Carotid intima-media thickness (cIMT), carotid distensibility coeffi-cient (cDC), and carotid-femoral pulse wave velocity (PWV), were measured in children and adolescents with T1D and SFK. Blood Pressure (BP; both central and peripheral), echocardiographic measurements, biochemical data from blood and urine sample and other cardiovascular risk factors were evaluated in multi-variate linear regressions to assess the association with the measured indices of subclinical vascular damage. Results study 1. One hundred and twenty-six children and adolescents with T1D were included. cIMT was above the 95th percentile for age and height in 61% of the population. Bivariate correlations showed that cBP but not peripheral blood pressure (pBP) were positively associated with cIMT (r = 0.285; p = 0.001). In-dependent determinants of cIMT according to the regression models were only gender, type of glucose monitoring and central systolic BP (cSBP). PWV was as-sociated with age, sex, heart rate, and cSBP; cDC with age and both cSBP, and, alternatively, peripheral BP (pBP). Neither pBP nor any of the tested metabolic parameters, including glycated hemoglobin, were associated with PWV and cIMT. Results study 2. 48 SFK children and adolescents were included. Of them 50% had increased cIMT. cBP was correlated with all vascular indices measured and with the left ventricular mass (r = 0.417; p = 0.005) but not with RWT. pBP cor-related with distensibility, with PWV and with the LVMi. Daytime systolic blood pressure was found to be associated with all vascular indices but not with echo-cardiographic ones. BMI correlated with the variables indicative of organ dam-age and with many pressure variables. No correlation was found between the vas-cular or echocardiographic indices and either estimated glomerulaf filtration rate or urinary albumin to creatinine ratio. In linear regression pBP were not associat-ed with the above-mentioned vascular variables whereas cBP was positively as-sociated with cIMT (even when we consider z-score values). To the contrary, cDC and PWV were not associated with cBP. In binary logistic regression analy-sis, cBP was a predictor for increased cIMT. Conclusions: Taken together, our data show a high prevalence of increased cIMT in children and adolescents with T1D and SFK. cBP more than pBP or other tra-ditional risk factors associates with subclinical organ damage.