NHLBI Working Group
Cardiovascular Complications of Type 1 Diabetes:
Identifying New Opportunities for Prevention and Treatment
Executive Summary
The National Heart, Lung, and Blood Institute (NHLBI), the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK),
and the Juvenile Diabetes Research Foundation (JDRF) convened
a Working Group of investigators on April 27-28, 2003, in Bethesda,
Maryland. The purpose of this meeting was to identify ways to
close the gaps in our knowledge about the development of cardiovascular
(CV) complications in Type 1 diabetic patients and to identify
opportunities for future studies to elucidate the causes and improve
treatments for this major chronic complications in middle-aged
Type 1 diabetic patients. The two major objectives for this meeting
were: 1) to evaluate opportunities for studies to answer fundamental
questions about the pathogenesis of CV complications among patients
with type 1 diabetes and 2) to evaluate opportunities for intervention
studies to reduce CV complications among patients with Type 1
diabetes.
The following recommendations in priority order were made to the
NHLBI, NIDDK, and JDRF:
- Support mechanistic studies involving the vascular wall,
endothelial dysfunction, and the role of inflammation and
the immune system in the onset and progression of cardiovascular
complications in Type 1 diabetes.
- In existing Type 1 diabetes cohorts, support clinical ancillary
studies related to cardiovascular complications such as the
role of inflammatory cytokines, adhesion molecules and molecular
and inflammatory mediators.
- Encourage the validation of newly developed functional and
molecular imaging techniques that could be utilized in Type
1 diabetes to document development and progression of subclinical
and clinical cardiovascular disease.
- Expand our understanding of the natural history and progression
of cardiovascular disease in Type 1 diabetes, focusing on
the development of reliable biomarkers of CVD. Large clinical
trial data bases, such as the Epidemiology of Diabetes Interventions
and Complications (EDIC) trial may be particularly useful.
- Using biomarkers and imaging techniques to measure CVD outcomes,
encourage pilot clinical trials to identify new therapies
and interventions to address CVD in Type 1 diabetes.
- Support data analyses and evaluate outcomes relevant to cardiovascular
disease form the Epidemiology of Diabetes Interventions and
Complications (EDIC) trial.
Working Group Members
Co-Chairs:
- Peter Libby, M.D., Brigham and Women's Hospital, Department
of Medicine, Boston
- David Nathan, MD, Director, General Clinical Research Center,
Director, MGH Diabetes Center, Boston
Members:
- Robert Balaban, MD, NIH-NHLBI, Bethesda
- John D. Brunzell, MD, Department of Medical Metabolism, University
of Washington, Seattle
- Jeffrey Carr, MD, Dept. of Radiology and Public Health Sciences,
Wake Forest University School of Medicine, Winston-Salem
- Antonio Ceriello, Department of Pathology and Medicine, Clinical
and Experimental Chair, Internal Medicine, University of Udine,
Udine, Italy
- Allan Collins, MD, Department of Medicine, Nephrology Analytic
Service, Minneapolis Medical Research Foundation, Minneapolis
- Timothy Garvey, MD, Medical University of South Carolina,
Division of Endocrinology, Medicine/Diabetes and Medical Genetics,
Charleston
- Steven M. Haffner, MD, MPH, Department of Medicine and Epidemiology,
University of Texas Health Science Center at San Antonio
- Willa Hsueh, MD, Department of Medicine and Endocrinology,
University of California, Los Angeles
- Michael R. Jirousek, Ph.D., Pfizer Global Research and Development,
LaJolla Laboratories, San Diego
- Bertram Kasiske, MD, Department of Medicine, Division of Renal/Dis/Hy,
University of Minnesota, Minneapolis
- Susan Laing, Section of Epidemiology, The Institute of Cancer
Research, London, UK
- Steven Nissen, MD, Medical Director, Cleveland Clinic Cardiovascular
Coordinating Center, The Cleveland Clinic Foundation, Cleveland
- Trevor Orchard, Ph.D., University of Pittsburgh, Dept of Epidemiology,
Pittsburgh
- Donald Orlic, Ph.D., Genetics and Molecular Biology Branch
- NHGRI, Bethesda
- John R. Petrie, Ph.D., University of Glasgow, Department
of Medicine and Therapeutics, Scotland, UK
- Marian Rewers, MD, Ph.D., University of Colorado, Department
of Preventive Medicine/Biometric, Denver
- Neil Ruderman, MD, Boston Medical Center, Department of Medicine,
Boston
- Anne Marie Schmidt, MD, Columbia University, Department of
Surgery, New York
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