Circulation: Heart failure risk in people with type 1 diabetes linked to heart dilation

Introduction: Type 1 diabetes, originally known as insulin-dependent diabetes, occurs mostly in children and adolescents and can also occur at any ageThe onsmeis is relatively acute, the body insulin is relatively insufficient, easy to develop ketoacidosis, must use insulin therapy to obtain satisfactory results, otherwise it will be life-threateningPeople with type 1 diabetes, especially those with poor blood sugar control, have significantly higher risk of cardiovascular disease than the general populationConfusingly, many risk factors for cardiovascular disease in people with type 1 diabetes are not consistent with known risk factors associated with type 2 diabetesDr Myra Lipes, a researcher in the immunobiology branch of the Joslin Diabetes Center at Harvard Medical School, who has been studying for more than a decade what exactly is the cause of the high risk of cardiovascular disease in people with type 1 diabetes and what should be done"Heart failure is particularly described as a major complication of type 1 diabetes," DrLipes saidStudies based on the National Register show a 10-fold increase dis-risk risk of heart failure in people with poor blood sugar controlIn addition, type 1 diabetes has a higher fatality rate than type 2 diabetes, suggesting that different mechanisms of heart failure may be associated with type 1 diabetes"Given the burden of heart failure in type 1 diabetes, it is important to identify patients at high risk at an early stageNew research in DrJocelyn Lipes's lab shows that there is no known cardiovascular disease in patients with type 1 diabetes, and the emergence of autoantibodies of myocardial protein is associated with magnetic resonance (CMR)Increased volume of the left ventricle (the main power region of the heart) in cardiac magnetic resonance tests, increased heart muscle mass, and decreased pumping blood function (blood score), all of which were associated with high-risk heart failureThe new study was published in the journal Circulationantibodies are generally produced by the immune system and circulate in the body's blood, playing an important role in the body's fight against infectionIn people with autoimmune tendencies, the body misidentifies its own proteins as threats and attacks That's what people with type 1 diabetes face - the immune system thinks islet beta cells are intruders and want to destroy them In this state, antibodies are also known as autoantibodies So it's no surprise that the complications of type 1 diabetes have the wrong immune response to myocardial cells In this study, Dr Lipes wanted to determine whether the heart dilating phenomenotype seen in mouse models and Chagas patients was also present in patients with type 1 diabetes with these circulating autoantibodies Dr Lipes and her team used data from participants in the Post Diabetes Control and Complications Trial (DCCT) Diabetes Intervention and Complications Epidemiology (EDIC) follow-up study, including people with type 1 diabetes for an average of 28 years As part of the study, participants used CMR to image the heart, a gold standard non-invasive imaging technique that evaluates the structure and function of the heart "In this study, we measured 892 EDIC participants withnosic cardiovascular disease who had an autoantibody of myocardial protein in a blood sample taken during CMR imaging," Lipes said.
"We then examined the relationship between the presence of heart antibodies and CMR evidence for cardiac dysfunction researchers found that although recent A1c levels were similar to those in participants without heart autoantibodies, the presence of autoantibodies in the heart identified patients with poor blood sugar control in the past, suggesting that heart autoantibodies were a marker of long-term blood sugar exposure In addition, the researchers found that two or more of these autoantibodies showed heart dilation in people with CMR scans The researchers classified patients based on the number of autoantibodies in the cycle, suggesting that people with more of this particular autoantibodies had more significant changes in the heart These findings were not weakened by the adjustment of traditional cardiovascular risk factors, suggesting that these changes were mainly due to cardiac immunity they have learned from previous studies that the heart may experience structural and functional changes associated with metabolic problems with diabetes itself; For example, higher levels of glycated hemoglobin are associated with smaller left ventricular volume, but have no clinical significance But this study suggests that higher glycifying hemoglobin levels can trigger an additional autoimmune response that damages the heart in a different, more visible way, leading to increased heart disease and deterioration of function, characteristics thought to be associated with a high errony ingrisky heart failure "It's a new process involving the heart and is associated with poor blood sugar control in type 1 diabetes," Lipes said.
because heart autoantibodies can be detected in a simple blood test, this study opens up a new avenue for detecting potential heart failure in people with type 1 diabetes "Given the high burden of heart failure in people with type 1 diabetes, heart antibodies may make it possible to identify people at higher risk of heart failure early on," Lipes said "Of course, it is important to understand the underlying causes of heart failure, as it may lead to targeted treatments to improve the prognosis of these patients "