Modifiable Factors Influence Racial, Ethnic Differences in PWV in Youth with T1D

Katherine A. Sauder, PhD

Courtesy of University of Colorado

A recent analysis indicates that a significant proportion of racial and ethnic disparities in subclinical cardiovascular disease (CVD) among youth with type 1 diabetes (T1D) may result from modifiable cardiovascular and socioeconomic factors present within the first 11 years of diabetes.¹

The investigative team found that arterial stiffness, as measured by carotid-femoral pulse wave velocity (PWV), was significantly higher in non-Hispanic Black individuals compared to non-Hispanic White individuals in all analytic models. This finding suggests the need to consider other factors involved in these ongoing differences.

“While our participants with T1D are not yet experiencing major adverse cardiovascular events, these data demonstrate that an important precursor to cardiovascular disease (CVD) manifests with apparent racial and ethnic differences as early as the third decade of life,” investigators wrote. “Because race and ethnicity are social (not biological) constructs, our analysis clarified important modifiable contributors that explain, at least in part, these apparent racial and ethnic differences in this population.”

The team, led by Katherine A. Sauder, PhD, LEAD Center, University of Colorado Anschutz, explored how modifiable risk factors in the first two decades of T1D are related to arterial stiffness in early adulthood and how they may explain racial and ethnic differences in arterial stiffness. Sauder and colleagues focused on arterial stiffness, given its prevalence as a risk factor for clinical CVD.

Using The SEARCH for Diabetes in Youth Study, investigators identified individuals aged <20 years with newly diagnosed diabetes between 2002 – 2018. Participants completed 2 to 3 research visits from 10 months to 11 years post type 1 diabetes diagnosis. Investigators explored the differences between racial and ethnic groups, using variables grouped within risk factor domains (socioeconomic, T1D characteristics, CVD risk factors, behavioral health, quality of clinical care, and perception of care). The base model was adjusted for sex, age, heart rate, and mean arterial pressure at PWV measurement, as well as SEARCH study site.

Of 1224 participants with T1D at the second follow-up visit, 1162 identified as Hispanic, non-Hispanic Black, or non-Hispanic White and were included in the analysis. Within the base model, PWV was significantly higher in Hispanic versus non-Hispanic White participants. Investigators noted statistically significant differences in PWV between Hispanic and non-Hispanic participants persisted in all domain models except those for cardiovascular risks and socioeconomic factors.

In the cardiovascular risks model, the mean difference in PWV decreased by 15% and was attenuated to statistical non-significance (P = .056), while in the socioeconomic model, the mean differences in PWV decreased by 27% and was deemed statistically non-significant (P = .12). In the full model, data showed no significant differences in PWV between Hispanic and non-White participants (P = .07) and the mean difference decreased 15% from the base model.

Additionally, in the base model, PWV was significantly higher in non-Hispanic Black versus both Hispanic and non-Hispanic White participants. Investigators noted statically significant differences in PWV between Hispanic and non-Hispanic Black participants persisted in all models except the full model, in which the difference decreased by 25% and was no longer significant (P = .08).

Meanwhile, statistically significant differences in PWV between non-Hispanic Black and non-Hispanic White participants persisted in all models. Within the full model, the mean difference decreased by 21% but remained statistically significant (P <0.0001).

The variables associated with significantly lower PWV included never missing medications due to cost, body mass index (BMI) <25 kg/m², and hypertension therapy prescribed when applicable. On the other hand, variables associated with significantly higher PWV included non-Hispanic race, older age at PWV measurement, and excellent or good rating of overall T1D care.

Unlike other studies that highlight clinical factors as the major contributor to CVD disparities, Sauder and colleagues found that socioeconomic factors explained the largest proportion of PWV disparities in their study. This could be attributed to the younger age of participants who have not yet developed age-related CVD risk factors, while socioeconomic factors may have a long-lasting impact on health from early life.

“We do note that in the socioeconomic domain model and the fully adjusted model, the only socioeconomic variable that was significantly related to PWV was missed diabetes medication in the prior year because of cost,” they wrote. “Thus, our work underscores the importance of improving access to affordable care across the increasingly diverse population of individuals with youth-onset T1D.”

References

1. Sauder KA, Glueck DH, Harrall KK, et al. Exploring Racial and Ethnic Differences in Arterial Stiffness Among Youth and Young Adults With Type 1 Diabetes. J Am Heart Assoc. 2023;12(7):e028529. doi:10.1161/JAHA.122.028529