CARDIOVASCULAR RISK ASSESSMENT IN PATIENTS WITH TYPE 1 DIABETES MELLITUS

Cardiovascular disease (CVD) is a major cause of death in type 1 diabetes mellitus (T1DM). Management of CVD risk factors in T1DM patients is based on evidence, mostly extrapolated from T2DM studies. Hyperglycemia, leading to the induction of oxidative stress, is considered a key pathophysiological mechanism for the development of micro- and macrovascular complications. Biochemical processes related to it directly damage monocyte function, and also indirectly affect the function of monocyte cells, through the synthesis of growth factors, cytokines and vasoactive mediators in other cells. However, the epidemiologic relationship between glycemia and CVD is not fully understood. The aim of the present review is a systematic analysis of potential laboratory biomarkers for the assessment of cardiovascular risk in T1DM patients, with particular attention paid to asymmetric dimethylarginine (ADMA), adiponectin (ADPN) and osteoporotegerin (OPG) as such. The available literature suggests a significant burden of CVD in patients with T1DM and poor management of risk factors. This is based on the poor evidence base for therapeutic management of CVD risk in T1DM patients. The clinical implications of the epidemiological and pathophysiological aspects of the relationship between T1DM and CVD are discussed. We have reviewed the available literature noting areas where sufficient clarity is lacking. More and more clinical studies are validating the capabilities of new classes of laboratory biomarkers that characterize cardiovascular changes in patients with T1DM.