Microvascular degenerative complications are associated with increased aortic stiffness in type 2 diabetic patients
Introduction
In recent years, there is a growing knowledge on the importance of arterial stiffness in the pathogenesis of cardiovascular diseases [1], [2]. Arterial stiffness depends on the structural and geometric properties of the arterial wall and on the distending pressure, and ageing and blood pressure (BP) are its main determinants [1], [2]. The measurement of aortic pulse wave velocity (PWV) is considered the gold-standard evaluation of arterial stiffness [1]. Furthermore, aortic stiffness has been demonstrated to predict cardiovascular morbidity and mortality above and beyond other traditional cardiovascular risk factors [3], [4], [5], [6].
Type 2 diabetic patients have increased arterial stiffness [7], [8], [9] and are at particularly augmented risk for cardiovascular morbidity and mortality. This high cardiovascular risk is not completely explained by clustering of traditional risk factors and increased arterial stiffness may be one pathophysiological mechanism linking diabetes to increased cardiovascular morbi-mortality [10]. Nevertheless, factors associated with increased arterial stiffness in diabetic patients have not been completely explored, particularly the relationships with microvascular complications. In this regard, previous studies have generally addressed specific microvascular complications, such as microalbuminuria [11], [12], renal failure [13], retinopathy [14], [15], cardiovascular dysautonomy [16] or neuropathy [17], without a comprehensive analysis of all microvascular complications. Furthermore, it was recently demonstrated [18] that the presence of diabetic retinopathy was a risk marker for cardiovascular mortality. Hence, we hypothesized that increased arterial stiffness may be the pathophysiological link between microvascular damage and macrovascular clinical events.
Therefore, we planned to investigate the multivariate correlates of increased arterial stiffness, assessed by aortic and peripheral PWV, in a cohort of patients with type 2 diabetes, with particular attention to the relationships between increased stiffness and the presence of microvascular complications.
Section snippets
Study patients and baseline procedures
It was a cross-sectional study within a cohort of 540 type 2 diabetic patients enrolled from August 2004 to December 2007 in the outpatient clinic of a tertiary-care university hospital. Criteria to consider diabetes as type 2 was the diagnosis after 30 years old and to have remained on oral anti-diabetic treatment without insulin use for at least 1 year after diagnosis. Exclusion criteria to enter the cohort have been reported elsewhere [19]. All patients gave written informed consent and
Baseline characteristics and bivariate comparisons between patients with and without increased arterial stiffness
Aortic PWV averaged 11.14 m/s (SD: 2.37, range: 6.33–21.90 m/s) and peripheral PWV 10.56 m/s (SD: 1.53, range: 6.17–16.00 m/s); both had normal distributions. One hundred forty-eight patients (31%) had increased aortic stiffness, whereas 75 patients (16%) had increased peripheral arterial stiffness. Patients with increased peripheral PWV were more frequently males (62% vs. 33%, p < 0.001), and had higher ambulatory 24 h SBP (134 ± 17 vs. 128 ± 15 mmHg, p = 0.006) and DBP (80 ± 11 vs. 73 ± 9 mmHg, p < 0.001) than
Discussion
This study has two main findings: first, it demonstrates that the presence of diabetic retinopathy, nephropathy (microalbuminuria appears to be its most important component) and peripheral neuropathy are associated with increased central aortic stiffness, independent of other established determinants of aortic stiffness, such as ageing, BP levels and other cardiovascular risk factors; whereas peripheral arterial stiffness is not associated with any diabetes-related variable. Second, it confirms
References (25)
- et al.
Arterial stiffness is associated with diabetic retinopathy in type 2 diabetes
Diab Res Clin Pract
(2005) - et al.
Expert consensus document on arterial stiffness: methodological issues and clinical applications
Eur Heart J
(2006) - et al.
Recent advances in arterial stiffness and wave reflection in human hypertension
Hypertension
(2007) - et al.
Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients
Hypertension
(2001) - et al.
Aortic pulse wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function?
Circulation
(2002) - et al.
Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam study
Circulation
(2006) - et al.
Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population
Circulation
(2006) - et al.
Correlation between the intima-media thickness of carotid artery and aortic pulse wave velocity in patients with type 2 diabetes Vessel wall properties in type 2 diabetes
Diab Care
(1999) - et al.
Preferential stiffening of central over peripheral arteries in type 2 diabetes
Diabetes
(2003) - et al.
Sex differences in age-related stiffening of aorta in subjects with type 2 diabetes
Hypertension
(2004)
Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiovascular disease
Diabetologia
Aortic pulse wave velocity and albuminuria in patients with type 2 diabetes
J Am Soc Nephrol
Cited by (65)
Cardio-ankle vascular index is associated with diabetic retinopathy in younger than 70 years patients with type 2 diabetes mellitus
2019, Diabetes Research and Clinical PracticeCitation Excerpt :This relationship was weaker and not significant in older patients. Our finding supports the results of previous studies [21,22] investigating the association between DR and arterial stiffness assessed by the carotid-femoral PWV (cfPWV) [23]. However, due to the time-consuming of this method which is partly operator dependent, cfPWV measurement has not become part of the daily routine in clinical work up of T2DM patients.
Retinal vessel reactivity is not attenuated in patients with type 2 diabetes compared with matched controls and is associated with peripheral endothelial function in controls
2019, Journal of Diabetes and its ComplicationsUsefulness of the vibration perception thresholds measurement as a diagnostic method for diabetic peripheral neuropathy: Results from the Rio de Janeiro type 2 diabetes cohort study
2018, Journal of Diabetes and its ComplicationsThe effects of metformin on maternal haemodynamics in gestational diabetes mellitus: A pilot study
2018, Diabetes Research and Clinical PracticeAtomic Force Microscopy-Based Measurements of Retinal Microvessel Stiffness in Mice with Endothelial-Specific Deletion of CCN1
2023, Methods in Molecular Biology