Digital Public Defence: Vibeke Bratseth

In patients with diabetes mellitus (DM) accelerated atherosclerosis, cardiovascular disease (CVD) and atherothrombotic events are the major reasons for morbidity and mortality. Circulating microvesicles (cMVs), shed from the plasma membrane of activated and apoptotic cells, assess procoagulant properties. Exercise training is shown to be beneficial in patients with DM and in those with established CVD, however, in patients with combined diseases, long-term effects of exercise training, especially on prothrombotic activity is less explored. In the “EXercise training in patients with Coronary Artery disease and type 2 DIabetes” (EXCADI) study in which patients were randomized to 150 min organized exercise training per week or conventional follow-up for one-year, we investigated the effect on cMVs and selected markers of prothrombotic activity and the thrombin generation potential (n= 131). One-year exercise training had no significant effect on prothrombotic activity, independent of disease severity. Overall, our results thus contribute to safety of exercise training in this high-risk population. Hypercoagulability as well as cMVs from activated endothelial cells associated strongly with the presence of albuminuria, confirming the procoagulant state in these patients. In children and adolescents with type 1 DM (T1D) (n= 314) compared with healthy controls (n= 120), all participating in the prospective cohort “Atherosclerosis and Childhood Diabetes” (ACD), we explored the prothrombotic state and cMVs. In a five-year perspective, the T1D group showed comparable prothrombotic activity as healthy controls, indicating absence of thrombotic traits at this younger age. However, children/adolescents with T1D presented with higher levels of tissue factor pathway inhibitor (TFPI) that associated with deteriorated glycemic control, indicative of endothelial activation, and highlighting the importance of strict glycemic control.