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Diabetologia
Published in: Diabetologia 6/2010

01-06-2010 | Article

Impact of metabolic indices on central artery stiffness: independent association of insulin resistance and glucose with aortic pulse wave velocity

Authors: D. R. Webb, K. Khunti, R. Silverman, L. J. Gray, B. Srinivasan, P. S. Lacy, B. Williams, M. J. Davies

Published in: Diabetologia | Issue 6/2010

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Abstract

Aims/hypothesis

Non-invasive measures of aortic stiffness reflect vascular senescence and predict outcome in diabetes. Glucose-mediated elastic artery sclerosis may play an integral role in the development of macrovascular complications. We used carotid–femoral pulse wave velocity (cfPWV) to quantify independent associations of fasting glucose, post-challenge glucose and derived insulin resistance (HOMA-IR) with aortic stiffness.

Methods

cfPWV was measured using a 4 MHz continuous wave Doppler ultrasound probe within groups with newly identified age- and sex-matched normal glucose metabolism (NGM), impaired glucose regulation (IGR) and diabetes mellitus populations (n = 570, mean age 59.1, 56% male).

Results

After multivariate adjustment, IGR and diabetes were associated with significant aortic stiffening compared with NGM (adjusted cfPWV±SE: NGM, 9.15 ± 0.12 m/s; IGR 9.76 ± 0.11 m/s, p < 0.001; diabetes, 9.89 ± 0.12 m/s, p < 0.001). IGR stratification indicated that impaired fasting glucose (IFG; 9.71 ± 0.12 m/s) and post-challenge (impaired glucose tolerance; 9.82 ± 0.24 m/s) categories had similar cfPWV (p = 0.83). Modelled predictors of cfPWV were used to assess independent metabolic associations with arterial stiffness. Fasting glucose concentration (β = 0.10; 95% CI 0.05, 0.18; p = 0.003), 2 h post-challenge glucose (β = 0.14; 95% CI 0.02, 0.23; p < 0.001) and HOMA-IR (β = 0.20, 95% CI 0.05, 0.53; p < 0.001) were independently related to cfPWV after adjustment for age, sex, mean arterial pressure, heart rate, body mass index, renal function and antihypertensive medication.

Conclusions/interpretation

IGR characterised by fasting or post-challenge hyperglycaemia is associated with significant vascular stiffening. Post-challenge glucose and HOMA-IR are the most powerful metabolic predictors of arterial stiffness, implying hyperglycaemic excursion and insulin resistance play important roles in the pathogenesis of arteriosclerosis.
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Metadata
Title
Impact of metabolic indices on central artery stiffness: independent association of insulin resistance and glucose with aortic pulse wave velocity
Authors
D. R. Webb
K. Khunti
R. Silverman
L. J. Gray
B. Srinivasan
P. S. Lacy
B. Williams
M. J. Davies
Publication date
01-06-2010
Publisher
Springer-Verlag
Published in
Diabetologia / Issue 6/2010
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-010-1689-9

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