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Cardiovascular Diabetology
Published in: Cardiovascular Diabetology 1/2012

Open Access 01-12-2012 | Original investigation

Determinants of vascular function in patients with type 2 diabetes

Authors: Katerina K Naka, Katerina Papathanassiou, Aris Bechlioulis, Nikolaos Kazakos, Konstantinos Pappas, Stelios Tigas, Dimitrios Makriyiannis, Agathocles Tsatsoulis, Lampros K Michalis

Published in: Cardiovascular Diabetology | Issue 1/2012

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Abstract

Background

Type 2 diabetes mellitus (T2DM) is independently associated with an increased risk for cardiovascular diseases that is primarily due to the early development of advanced atherosclerotic vascular changes. The aim of our study was to investigate the predictors of vascular dysfunction in T2DM patients.

Methods

We studied 165 T2DM patients without known macrovascular or microvascular disease. Standard demographic (age, gender, cardiovascular risk factors, medications), clinical (body mass index, blood pressure) and laboratory (glucose, glycated hemoglobin, lipids, renal function) parameters were included in analyses. Brachial artery flow-mediated dilation (FMD), nitrate mediated dilation (NMD) and Carotid-Femoral Pulse Wave Velocity (PWV) were measured.

Results

Median age was 66 years and duration since T2DM diagnosis was 10 years, 70% were females and 79% hypertensives, while only 10% had a glycated hemoglobin <7%. FMD was positively associated with NMD (r 0.391, P < 0.001), while PWV was inversely associated with FMD (r -0.218, P = 0.014) and NMD (r -0.309, P < 0.001). Time since diagnosis of diabetes was the single independent predictor of FMD (β -0.40, P = 0.003). Increased age and fasting glucose and the presence of hypertension were independent predictors of decreased NMD (P < 0.001). Increased age and systolic blood pressure were independently associated with increased PWV (P < 0.001).

Conclusions

In T2DM patients, impairment of endothelium-dependent vasodilation was independently associated only with longer diabetes duration while no association with other established risk factors was found. Vascular smooth muscle dysfunction and increased arterial stiffness were more prominent in older T2DM patients with hypertension. Worse glycemic control was associated with impaired vascular smooth muscle function.
Literature
1.
Engelgau MM, Geiss LS, Saaddine JB, Boyle JP, Benjamin SM, Gregg EW, Tierney EF, Rios-Burrows N, Mokdad AH, Ford ES, Imperatore G, Narayan KM: The evolving diabetes burden in the United States. Ann Intern Med. 2004, 140: 945-950.CrossRefPubMed
2.
Scholte AJ, Schuijf JD, Kharagjitsingh AV, Jukema JW, Pundziute G, van der Wall EE, Bax JJ: Prevalence of coronary artery disease and plaque morphology assessed by multi-slice computed tomography coronary angiography and calcium scoring in asymptomatic patients with type 2 diabetes. Heart. 2008, 94: 290-295. 10.1136/hrt.2007.121921.CrossRefPubMed
3.
Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM: Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999, 99: 2434-2439. 10.1161/01.CIR.99.18.2434.CrossRefPubMed
4.
Schachinger V, Britten MB, Zeiher AM: Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation. 2000, 101: 1899-1906. 10.1161/01.CIR.101.16.1899.CrossRefPubMed
5.
Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, Ducimetiere P, Benetos A: Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001, 37: 1236-1241. 10.1161/01.HYP.37.5.1236.CrossRefPubMed
6.
Boutouyrie P, Tropeano AI, Asmar R, Gautier I, Benetos A, Lacolley P, Laurent S: Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension. 2002, 39: 10-15. 10.1161/hy0102.099031.CrossRefPubMed
7.
Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG: Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function?. Circulation. 2002, 106: 2085-2090. 10.1161/01.CIR.0000033824.02722.F7.CrossRefPubMed
8.
Gokce N, Keaney JF, Hunter LM, Watkins MT, Nedeljkovic ZS, Menzoian JO, Vita JA: Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients with peripheral vascular disease. J Am Coll Cardiol. 2003, 41: 1769-1775. 10.1016/S0735-1097(03)00333-4.CrossRefPubMed
9.
Hatsuda S, Shoji T, Shinohara K, Kimoto E, Mori K, Fukumoto S, Koyama H, Emoto M, Nishizawa Y: Regional arterial stiffness associated with ischemic heart disease in type 2 diabetes mellitus. J Atheroscler Thromb. 2006, 13: 114-121. 10.5551/jat.13.114.CrossRefPubMed
10.
Kullo IJ, Malik AR, Bielak LF, Sheedy PF, Turner ST, Peyser PA: Brachial artery diameter and vasodilator response to nitroglycerine, but not flow-mediated dilatation, are associated with the presence and quantity of coronary artery calcium in asymptomatic adults. Clin Sci (Lond). 2007, 112: 175-182. 10.1042/CS20060131.CrossRef
11.
McVeigh GE, Brennan GM, Johnston GD, McDermott BJ, McGrath LT, Henry WR, Andrews JW, Hayes JR: Impaired endothelium-dependent and independent vasodilation in patients with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia. 1992, 35: 771-776.PubMed
12.
Goodfellow J, Ramsey MW, Luddington LA, Jones CJ, Coates PA, Dunstan F, Lewis MJ, Owens DR, Henderson AH: Endothelium and inelastic arteries: an early marker of vascular dysfunction in non-insulin dependent diabetes. BMJ. 1996, 312: 744-745. 10.1136/bmj.312.7033.744.PubMedCentralCrossRefPubMed
13.
Watts GF, O’Brien SF, Silvester W, Millar JA: Impaired endothelium-dependent and independent dilatation of forearm resistance arteries in men with diet-treated non-insulin-dependent diabetes: role of dyslipidaemia. Clin Sci (Lond). 1996, 91: 567-573.CrossRef
14.
van de Ree MA, Huisman MV, de Man FH, van der Vijver JC, Meinders AE, Blauw GJ: Impaired endothelium-dependent vasodilation in type 2 diabetes mellitus and the lack of effect of simvastatin. Cardiovasc Res. 2001, 52: 299-305. 10.1016/S0008-6363(01)00379-0.CrossRefPubMed
15.
Tan KC, Chow WS, Ai VH, Metz C, Bucala R, Lam KS: Advanced glycation end products and endothelial dysfunction in type 2 diabetes. Diabetes Care. 2002, 25: 1055-1059. 10.2337/diacare.25.6.1055.CrossRefPubMed
16.
Henry RM, Ferreira I, Kostense PJ, Dekker JM, Nijpels G, Heine RJ, Kamp O, Bouter LM, Stehouwer CD: Type 2 diabetes is associated with impaired endothelium-dependent, flow-mediated dilation, but impaired glucose metabolism is not; the Hoorn Study. Atherosclerosis. 2004, 174: 49-56. 10.1016/j.atherosclerosis.2004.01.002.CrossRefPubMed
17.
de Jager J, Dekker JM, Kooy A, Kostense PJ, Nijpels G, Heine RJ, Bouter LM, Stehouwer CD: Endothelial dysfunction and low-grade inflammation explain much of the excess cardiovascular mortality in individuals with type 2 diabetes: the Hoorn Study. Arterioscler Thromb Vasc Biol. 2006, 26: 1086-1093. 10.1161/01.ATV.0000215951.36219.a4.CrossRefPubMed
18.
Su Y, Liu XM, Sun YM, Wang YY, Luan Y, Wu Y: Endothelial dysfunction in impaired fasting glycemia, impaired glucose tolerance, and type 2 diabetes mellitus. Am J Cardiol. 2008, 102: 497-498. 10.1016/j.amjcard.2008.03.087.CrossRefPubMed
19.
Liye H, Lvyun Z, Guangyao S, Luping R: Investigation of early change of endothelial function and related factors in individuals with hyperglycemia. Diabetes Res Clin Pract. 2011, 92: 194-197. 10.1016/j.diabres.2011.01.018.CrossRefPubMed
20.
Lukich E, Matas Z, Boaz M, Shargorodsky M: Increasing derangement of glucose homeostasis is associated with increased arterial stiffness in patients with diabetes, impaired fasting glucose and normal controls. Diabetes Metab Res Rev. 2010, 26: 365-370. 10.1002/dmrr.1086.CrossRefPubMed
21.
Vyssoulis G, Pietri P, Vlachopoulos C, Alexopoulos N, Kyvelou SM, Terentes-Printzios D, Stefanadis C: Early adverse effect of abnormal glucose metabolism on arterial stiffness in drug naive hypertensive patients. Diab Vasc Dis Res. 2011, 9: 18-24.CrossRefPubMed
22.
Zhang M, Bai Y, Ye P, Luo L, Xiao W, Wu H, Liu D: Type 2 diabetes is associated with increased pulse wave velocity measured at different sites of the arterial system but not augmentation index in a Chinese population. Clin Cardiol. 2011, 34: 622-627. 10.1002/clc.20956.CrossRefPubMed
23.
Tsuchiya K, Nakayama C, Iwashima F, Sakai H, Izumiyama H, Doi M, Hirata Y: Advanced endothelial dysfunction in diabetic patients with multiple risk factors; importance of insulin resistance. J Atheroscler Thromb. 2007, 14: 303-309. 10.5551/jat.E525.CrossRefPubMed
24.
Nathan DM, Buse JB, Davidson MB, Heine RJ, Holman RR, Sherwin R, Zinman B: Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2006, 49: 1711-1721. 10.1007/s00125-006-0316-2.CrossRefPubMed
25.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J: A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009, 150: 604-612.PubMedCentralCrossRefPubMed
26.
Papathanassiou K, Naka KK, Kazakos N, Kanioglou C, Makriyiannis D, Pappas K, Katsouras CS, Liveris K, Kolettis T, Tsatsoulis A, Michalis LK: Pioglitazone vs glimepiride: differential effects on vascular endothelial function in patients with type 2 diabetes. Atherosclerosis. 2009, 205: 221-226. 10.1016/j.atherosclerosis.2008.11.027.CrossRefPubMed
27.
Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, Deanfield J, Drexler H, Gerhard-Herman M, Herrington D, Vallance P, Vita J, Vogel R: Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol. 2002, 39: 257-265.CrossRefPubMed
28.
Vlahos AP, Theocharis P, Bechlioulis A, Naka KK, Vakalis K, Papamichael ND, Alfantaki S, Gartzonika K, Mavridis A, Michalis LK, Siamopoulou A: Changes in vascular function and structure in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2011, 63: 1736-1744. 10.1002/acr.20613.CrossRef
29.
Yokoyama H, Sone H, Saito K, Yamada D, Honjo J, Haneda M: Flow-mediated dilation is associated with microalbuminuria independent of cardiovascular risk factors in type 2 diabetes - interrelations with arterial thickness and stiffness. J Atheroscler Thromb. 2011, 18: 744-752. 10.5551/jat.7526.CrossRefPubMed
30.
Beishuizen ED, Tamsma JT, Jukema JW, van de Ree MA, van der Vijver JC, Meinders AE, Huisman MV: The effect of statin therapy on endothelial function in type 2 diabetes without manifest cardiovascular disease. Diabetes Care. 2005, 28: 1668-1674. 10.2337/diacare.28.7.1668.CrossRefPubMed
31.
Tan KC, Ai VH, Chow WS, Chau MT, Leong L, Lam KS: Influence of low density lipoprotein (LDL) subfraction profile and LDL oxidation on endothelium-dependent and independent vasodilation in patients with type 2 diabetes. J Clin Endocrinol Metab. 1999, 84: 3212-3216. 10.1210/jc.84.9.3212.PubMed
32.
Wannamethee SG, Shaper AG, Whincup PH, Lennon L, Sattar N: Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk factors. Arch Intern Med. 2011, 171: 404-410. 10.1001/archinternmed.2011.2.CrossRefPubMed
33.
Bagg W, Whalley GA, Gamble G, Drury PL, Sharpe N, Braatvedt GD: Effects of improved glycaemic control on endothelial function in patients with type 2 diabetes. Intern Med J. 2001, 31: 322-328. 10.1046/j.1445-5994.2001.00072.x.CrossRefPubMed
34.
Barone Gibbs B, Dobrosielski DA, Bonekamp S, Stewart KJ, Clark JM: A randomized trial of exercise for blood pressure reduction in type 2 diabetes: effect on flow-mediated dilation and circulating biomarkers of endothelial function. Atherosclerosis. 2012, 10.1016/j.atherosclerosis.2012.07.035.
35.
Schalkwijk CG, Stehouwer CD: Vascular complications in diabetes mellitus: the role of endothelial dysfunction. Clin Sci (Lond). 2005, 109: 143-159. 10.1042/CS20050025.CrossRef
36.
37.
Williams SB, Cusco JA, Roddy MA, Johnstone MT, Creager MA: Impaired nitric oxide-mediated vasodilation in patients with non-insulin-dependent diabetes mellitus. J Am Coll Cardiol. 1996, 27: 567-574. 10.1016/0735-1097(95)00522-6.CrossRefPubMed
38.
Adams MR, Robinson J, McCredie R, Seale JP, Sorensen KE, Deanfield JE, Celermajer DS: Smooth muscle dysfunction occurs independently of impaired endothelium-dependent dilation in adults at risk of atherosclerosis. J Am Coll Cardiol. 1998, 32: 123-127. 10.1016/S0735-1097(98)00206-X.CrossRefPubMed
39.
Zhang X, Zhao SP, Li XP, Gao M, Zhou QC: Endothelium-dependent and -independent functions are impaired in patients with coronary heart disease. Atherosclerosis. 2000, 149: 19-24. 10.1016/S0021-9150(99)00288-9.CrossRefPubMed
40.
Bjarnegard N, Arnqvist HJ, Lindstrom T, Jonasson L, Jonsson A, Lanne T: Long-term hyperglycaemia impairs vascular smooth muscle cell function in women with type 1 diabetes mellitus. Diab Vasc Dis Res. 2009, 6: 25-31. 10.3132/dvdr.2009.005.CrossRefPubMed
41.
Shin JY, Lee HR, Lee DC: Increased arterial stiffness in healthy subjects with high-normal glucose levels and in subjects with pre-diabetes. Cardiovasc Diabetol. 2011, 10: 30-10.1186/1475-2840-10-30.PubMedCentralCrossRefPubMed
42.
Collaboration RVfAS: Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: ‘establishing normal and reference values’. Eur Heart J. 2010, 31: 2338-2350.CrossRef
43.
Chen Y, Huang Y, Li X, Xu M, Bi Y, Zhang Y, Gu W, Ning G: Association of arterial stiffness with HbA1c in 1,000 type 2 diabetic patients with or without hypertension. Endocrine. 2009, 36: 262-267. 10.1007/s12020-009-9221-z.CrossRefPubMed
44.
Yue WS, Lau KK, Siu CW, Wang M, Yan GH, Yiu KH, Tse HF: Impact of glycemic control on circulating endothelial progenitor cells and arterial stiffness in patients with type 2 diabetes mellitus. Cardiovasc Diabetol. 2011, 10: 113-10.1186/1475-2840-10-113.PubMedCentralCrossRefPubMed
45.
Yasmin , McEniery CM, Wallace S, Mackenzie IS, Cockcroft JR, Wilkinson IB: C-reactive protein is associated with arterial stiffness in apparently healthy individuals. Arterioscler Thromb Vasc Biol. 2004, 24: 969-974. 10.1161/01.ATV.zhq0504.0173.CrossRefPubMed
46.
Gomez-Marcos MA, Recio-Rodriguez JI, Patino-Alonso MC, Agudo-Conde C, Gomez-Sanchez L, Rodriguez-Sanchez E, Gomez-Sanchez M, Martinez-Vizcaino V, Garcia-Ortiz L: Relationships between high-sensitive C-reactive protein and markers of arterial stiffness in hypertensive patients. Differences by sex. BMC Cardiovasc Disord. 2012, 12: 37-10.1186/1471-2261-12-37.PubMedCentralCrossRefPubMed
47.
Anan F, Masaki T, Umeno Y, Iwao T, Yonemochi H, Eshima N, Saikawa T, Yoshimatsu H: Correlations of high-sensitivity C-reactive protein and atherosclerosis in Japanese type 2 diabetic patients. Eur J Endocrinol. 2007, 157: 311-317. 10.1530/EJE-07-0388.CrossRefPubMed
48.
Gomez-Marcos MA, Recio-Rodriguez JI, Patino-Alonso MC, Agudo-Conde C, Gomez-Sanchez L, Rodriguez-Sanchez E, Gomez-Sanchez M, Garcia-Ortiz L: Yearly evolution of organ damage markers in diabetes or metabolic syndrome: data from the LOD-DIABETES study. Cardiovasc Diabetol. 2011, 10: 90-10.1186/1475-2840-10-90.PubMedCentralCrossRefPubMed
49.
Johansen NB, Charles M, Vistisen D, Rasmussen SS, Wiinberg N, Borch-Johnsen K, Lauritzen T, Sandbaek A, Witte DR: Effect of intensive multifactorial treatment compared with routine care on aortic stiffness and central blood pressure among individuals with screen-detected type 2 diabetes: the ADDITION-Denmark study. Diabetes Care. 2012, 10.2337/dc12-0176.
Metadata
Title
Determinants of vascular function in patients with type 2 diabetes
Authors
Katerina K Naka
Katerina Papathanassiou
Aris Bechlioulis
Nikolaos Kazakos
Konstantinos Pappas
Stelios Tigas
Dimitrios Makriyiannis
Agathocles Tsatsoulis
Lampros K Michalis
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Cardiovascular Diabetology / Issue 1/2012
Electronic ISSN: 1475-2840
DOI
https://doi.org/10.1186/1475-2840-11-127

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