FUDiabetes

Crazy increased heart disease risk in T1Ds and how to mitigate that risk

#1

Not sure if anyone here saw the recent study showing a 30-fold!!! risk of cardiovascular disease in T1Ds who have early onset of the disease:


These are crazily high odds. (For those diagnosed at age 26 to 30, the odds are 3-fold higher – so being diagnosed young is just way worse for this particular complication)

And for us, it’s especially concerning as Samson was diagnosed when he was not yet 2-years-old. And on both sides of his family, heart disease is a big problem (my dad, his grandmother, grandfather and uncle).

While they think BG levels are certainly a factor, they don’t think that explains all of this increased risk.
I guess it’s reaffirming to me that we really need to be doing more to get Samson’s heart disease risk down now, while there’s lots of runway. WE need to be instilling good eating habits (veggies, unsaturated fats, fish, fiber, fruits, minimal processed foods) and we need to get him to love the kind of exercise that reduces cardiovascular risk.

But how? He’s 4. He’s picky. He eats a lot of cheese – mac n’ cheese, pizza, cheese sticks, and the like. He eats only 6 or 7 types of veggies and relatively few fruits. He doesn’t like hardly any fish except lox, sometimes. And while his brother loves running with mom, Samson’s physique and interests are more towards explosive, powerful movements like acrobatics or sprinting.

Does anyone have ideas how to get kids set up early to mitigate this risk? And for those who are older, how do you mitigate that risk?

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Joslin Medalists and the Medals
Reducing risk of CVD in your T1 child
#2

In another review of the study (on WeMD), I found this comment:

Still, study co-leader Araz Rawshani, a researcher at the University of Gothenburg, in Sweden, stressed that “although the relative risk of cardiovascular disease is increased after an early diabetes diagnosis, the absolute risk is low.”

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#3

So, I’ve been thinking about this. I think there’s no way the math adds up for the absolute risk to be low if you have a 30-fold increase in risk. At least, IF we’re talking about cardiovascular disease over the entire lifespan (into the 60s, 70s and 80s). Because heart disease is the second-leading cause of death, with one in four people succumbing to it, so a relative risk of 30 would be off-the-charts, right?

I feel like what this research is showing is a time-shift in when people are likely to develop heart disease. In other words, maybe a 40-year-old has a 1 in 1000 risk of having a heart attack, and now that person with early-onset T1D has a 3 in 100 risk of that happening. It’s almost like the complications of aging are just shifted earlier.

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#4

A very wise endocrinologist told me “the disease is NOT diabetes, it is high blood sugar.”

A plethora of risk can be mitigated by maintaining as close to normal blood sugar throughout one’s life.

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#5

@Tia, I think you are likely to have a problem forcing the food issue. One of my sons was a very picky eater when young, who now at 17, eats an amazing plethora of foods that are good for you.

I would model the good behavior you are expecting and worry as little as possible. He will most likely turn out to be a good eater in the end.

As far as the exercise, I think you have to expose them to many activities and see which one they gravitate to and like. For instance, one of my son’s friends switched from baseball to rowing in 10th grade, and absolutely loves rowing (which is good for the heart), but you would never have predicted he would be a rower when he was 6.

Have an expectation that he do some sport through high school, and let your son be the guide. When young you can control their activities and expose them to 3-4 sports a year, but in 6th - 7th grade they will begin focusing on 1-3 sports based on interest.

If you are looking for a sport that is explosive and can be done your whole life, tennis fits that bill.

Sorry for the rambling answer, to summarize, have a process, trust the process. Try not to worry too much, it isn’t good for your health.

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#6

I guess I don’t think that’s true. Or at least, it hasn’t been shown. You certainly can reduce a lot of risk with BG levels, but there are other autoimmune processes and inflammation going on that are not specifically caused by the BG levels, and that we don’t know how to mitigate.

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#7

@TiaG But how many of those studies include diabetics who have always been normoglycemic? ( if that person even exists).

Normalcy of Bg mitigates complications to the point where they are not out of line with non diabetic people. I don’t know how you would do a study to prove that but it’s my hypothesis.

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#8

I think you have to wait a while to get a real answer. However, I have to say that as reassuring as that is on one level, it’s not on another; Samson has had an A1C of 6.5 for about a year at least. That’s great for someone who is T1D (and really good compared to other little 4-year-olds) but it’s NOT normoglycemic. I do know that my dad who has T2, for instance, has had similar A1Cs for 20 years and still has developed various complications including heart disease, dementia, heart failure and neuropathy.

As an aside, the fact that T2s can run the same BGs but develop complications at higher rates is evidence that blood sugar levels are NOT the whole story.

#9

Let me start with just the overall issues from the disease from the medical view. But please don’t read this and get worried. After this, I will put together a list of things that can help you not be as concerned. Things that will help Samson for a lifetime.

This is just what you have to fight against. But there are workable solutions for all of this, and I really want to post that too. but it will take a bit of time to gather all my thoughts on it.

So just to start, here are a few of the reasons for cardiac troubles that I’ve been able to piece together over the years:

  1. Diabetics have a higher incidence of dyslipidemia (higher levels of total cholesterol, triglycerides, and LDL). http://www.globalresearchonline.net/journalcontents/v25-1/48.pdf

  2. Lack of sufficient insulin can raise the levels triglycerides, because insulin promotes the activity of the enzyme lipoprotein lipase, which helps allow free fatty acid uptake into adipose tissue (storage), which decreases the amount of free fatty acids in circulation.

  3. Insulin also suppresses the activity of the enzyme hormone-sensitive lipase (also known as cholesteryl ester hydrolase - CEH), which also decreases the free fatty acids in circulation.

  4. People with diabetes have been found to have decreased availability of nitric oxide (NO) from the endothelium. NO is a vasodilator, which widens blood vessels. The vasodilation relaxes the smooth muscle cells within the vessel walls and allows for better blood flow, better oxygen exchange, and reduced blood pressure.

  5. Diabetes are believed to have general low-level inflammation from the immune activation of the disease. Long term inflammation is believed to be a risk factor for the development of atherosclerosis.

  6. The long-term inflammation causes an increase in the activity of leukocytes, which increases the level of reactive oxygen species (ROS). Additionally, high BG in diabetics can cause the overproduction of ROS. the bottom line of this is that overproduction of ROS can cause damage to lipids, proteins and DNA. https://www.biotek.com/resources/white-papers/an-introduction-to-reactive-oxygen-species-measurement-of-ros-in-cells/ and www.ncbi.nlm.nih.gov/pmc/articles/PMC4055301

  7. Because of endothelial dysfunction, diabetics have a higher activation of platelets and clotting factors in the blood, which can cause higher levels of atherosclerosis. https://www.ahajournals.org/doi/abs/10.1161/01.cir.0000033634.60453.22

All of that sounds horrible, I know. But Samson can do things that will make him healthier than probably 90% of his peers. The difference is simply that he will do the right things, and his peers won’t.

Let’s spend some time focusing on what he needs to do. If he does the right things, it is really not that bad as all of this makes it sound.

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Reducing risk of CVD in your T1 child
#10

@TiaG, I know that as a mom you will worry no matter what, but hopefully this will help. I was diagnosed at the age of 8 in 1973. I can tell you that due to lack of technology my BGs were probably higher than desired for most of my childhood and young adult life. In my life today (at 54), I am fit, I eat a healthy diet, my BGs are in target most of the time, and I have a good A1C. My dad and both his brothers died at a young age (in their 50’s) from heart attacks (none of them had T1D or T2D), so I have a higher risk of heart disease. Right now I have a healthy heart. I have had stress tests and ECGs, and my cholesterol is good. I do take BP medications and statins preventatively. There are so many factors, other than T1D, that can contribute to heart disease and other diseases over a lifetime. My opinion is that all you can do in life is try your best to live a healthy life. The best thing that you can do for Samson is to teach him about exercise and nutrition and their benefits so that he can go into adulthood with the knowledge he needs to live a long healthy life.

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#11

@TiaG, 15 years ago I got a great tip from a lawyer friend of mine that made an enormous difference to how our kids grew up with food. This is what we did based on her suggestion:

When my kids where very young, around 4-5 years old, we had a discussion with them about food choices. We explained to them that we were going to sign a contract with them. In that contract, we, the parents, would agree that they could list 5 foods every quarter that we would never require them to eat. On the other hand, they would have to eat everything else. When they got to their 10th birthday, every year they would get to list one less food, until they were out of items by 14. The kids really liked the idea because they got a chance to avoid 5 foods, and, as for us, well, you know how we felt about avoiding arguments about food at meal time :slight_smile:

So, every quarter, on the first day, my kids would list 5 foods each, which have included onions, carrots, lettuce, fat (i.e. visible fat), etc. We would post them on a board in the kitchen. Then, every time they said they didn’t want to eat x or y, we would ask: “is it on your list?” That always was the end of the discussion. We always (well, at least for the past 12-13 years) build meals with a salad full of veggies to start with, cooked vegetables with the main dish, and fruits for desert. With the “contract” in place, we were able to provide them with a really balanced nutrition, and stop them from developing poor food habits for the many years to come.

My second son is turning 14 in a couple of months, so that will be the end of the food lists for us forever, but it has been an extraordinary tool for us! Now both of my kids eat absolutely everything (my 13-year-old has not given us any item to include on the food list for over 6 months!) and have turned out to be very adventurous eaters, although starting on the very cautious and bland end of the spectrum. I have been thrilled, in the past three months, to see my T1D teen order the weirdest items on the menus, and eat, day after day, a terrifically balanced diet full of fruits and vegetables. I often second guess myself about my kids’ education, but diet is something I feel really good about :slight_smile:

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#12

That’s great.

I have seen so many things improve with tighter control, that I am a firm believer in this. I think the big swings are also harmful, but high blood sugar is hard on the body for sure.

#13

The whole T1D and heart disease connection is terrifying to me. It is the only complication I am truly scared of. (I mean, not that I want any of the others, but I’d deal with them, because at least they wouldn’t kill me.)

I was diagnosed at age 9, and have had T1D for 27 years at this point. I’ve always had pretty decent control (A1c of 6-7% most of my life, with a few young adult years spent at 8%). Over this past year I’ve developed very high blood pressure and more recently I’ve been having arrhythmia problems and have had some abnormal test results. So this past week I was referred to a cardiologist to find out what is going on.

Hopefully it’s nothing serious and has no connection to heart disease or diabetes. I have enough other health conditions that it may well be completely unrelated. Still, having to worry about any type of heart issues in your 30s is not cool.

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#14

Also, I find this statement, referring to risk of developing heart disease and having a heart attack, even more alarming than the 30-fold increase. This is the group I fall into.

Among just the women with early-onset diabetes, those rates were 60 times and 90 times, respectively.

Reminds me of discussions we have had elsewehre on this forum about how outcomes tend to be worse for women with T1D than men with T1D. And, with heart disease in particular, how these worse outcomes by gender are opposite to what is seen in the general population.

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#15

I don’t want the “heart” this because it sounds scary. But I’m keeping my fingers crossed that it’s just an unrelated and (harmless) issue that is not a complication of diabetes. It’s scary for sure.

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#16

Looking forward to a follow up post with ideas for mitigating these tendencies. Don’t want to miss it!

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#17

I will post some things that can help mitigate it. But I want to wait until I have some time to put together a thoughtful post.

I will say this upfront - there is nothing magical. It takes effort. So much of what you have already heard. Boring things like proper diet, exercise, good BG management, etc.

But my ideas do differ a bit on perhaps what are some standard practices, so there may be a few new thoughts in it.

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#18

Boy howdy, thank goodness they do! I accidentally ate some “real” jello last night (!!!) and as I inhaled my Afrezza thought to myself, “I could have tried an IM injection”! :crazy_face:

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