ESPE Abstracts

Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in individuals with type 1 diabetes (T1D). Although the clinical manifestations of CVD are almost exclusively observed in adult life, their incidence represents the result of a long subclinical disease process, which is largely driven by potentially modifiable risk factors, including not only hyperglycaemia but also dyslipidaemia, hypertension, obesity, insulin resistance, lifestyle habits. In individuals with childhood-onset T1D, adolescence is a critical time for the development of early subclinical manifestations of CVD. Dyslipidemia is one of the major contributory factors for CVD in T1D, and young people with this condition often show quantitative and/or qualitative lipid abnormalities, which are not fully reversible with improved glycaemic targets. Screening for dyslipidaemia is strongly recommended by national and international guidelines to early identify lipid abnormalities and implement appropriate interventions. Although improving glycaemia and lifestyle interventions are the first step for the management of dyslipidaemia, these interventions are not always sufficient, and consideration should be given to the introduction of statins when indicated based on lipid targets. Statins have shown to be both effective and safe in young people with familial hypercholesterolemia and adults with diabetes, but their use in young people with T1D is still limited, due to the lack of long-term data in this population. The AdDIT trial, a randomized placebo-controlled trial in 443 adolescents with T1D, showed that treatment with statins during adolescence (for 2-4 years) leads to a substantial reduction in cholesterol levels, which could contribute to better CVD outcomes in the longer term. The trial also provided reassuring data on the safety profile of statins in this population. Although there is a need for longer-term data, based on current evidence, it is clear that early prevention and treatment of CVD risk factors such as dyslipidaemia will have long-term benefits and should be more widely used in paediatric T1D care.