People with type 1 diabetes, particularly those with poor glycemic control, are at markedly increased risk for cardiovascular disease than the general population. Even more puzzling, in individuals with type 1 diabetes, many of the risk factors for cardiovascular disease do not line up with the known risk factors associated with type 2 diabetes.
Dr. Myra Lipes, Investigator in the Section on Immunobiology at Joslin Diabetes Center at Harvard Medical School, has been working for more than a decade to understand exactly what leads to such increase risk of cardiovascular disease in patients with type 1 diabetes and what can be done about it.
Heart failure in particular has recently been recognized as an important complication of type 1 with national register-based studies showing tenfold increased risk of heart failure in individuals with poor glycemic control. In addition, there's a higher case fatality rate in type 1 than type 2 diabetes, which suggests different mechanisms for heart failure might be involved in type 1 diabetes." Dr. Myra Lipes, Investigator in the Section on Immunobiology at Joslin Diabetes Center at Harvard Medical School
Given the burden of heart failure in type 1 diabetes, the early identification of patients at particular risk is of importance.
New research from Dr. Lipes's lab at Joslin shows that in people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population. This new study was published in Circulation .
Antibodies are normally produced by the immune system and circulate in the blood, playing in important role in the body's defense against infection. In autoimmune-prone people, the body misidentifies its own proteins as threats and attacks. This is what happens in type 1 diabetes--the immune system thinks pancreatic beta cells are invaders and destroys them. In these situations, antibodies are called autoantibodies. So, perhaps it's not too surprising that this complication of type 1 diabetes also involves a faulty immune response against the heart muscle cells.
Previous studies run by Dr. Lipes' group have shown that mouse models of type 1 diabetes developed dilated cardiomyopathy (weakened heart muscle) and early heart failure associated with the presence of autoantibodies directed against heart muscle proteins. Her group has also shown that poor glycemic control in patients with type 1 diabetes - but not in those with type 2 diabetes - was associated with cardiac autoimmunity. An unexpected finding was the similar cardiac autoantibody levels in the patients with type 1 diabetes, who were young adult and without diabetes complications, and a heart failure cohort with Chagas' cardiomyopathy, which is thought to be caused by chronic inflammation of the heart muscle ("myocarditis"), raising the possibility of a subclinical autoimmune-associated myocardial dysfunction in type 1 diabetes " says Dr. Lipes. Related Stories
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