title: Aortic pulse wave velocity and albuminuria in patients with type 2 diabetes.
abstract: Development of microalbuminuria increases the risk for cardiovascular disease (CVD) in type 2 diabetes. The nature of this relationship is unclear but may involve arterial stiffness, an independent risk marker for CVD mortality. Aortic pulse wave velocity (Ao-PWV) and albumin creatinine ratio (ACR) were measured in 134 consecutive patients with type 2 diabetes without overt renal impairment (serum creatinine <150 micromol/L). ACR ranged from 0.2 to 153 mg/mmol. Patients with raised ACR (>/=3 mg/mmol) had higher Ao-PWV, poorer diabetic control, and higher pulse pressure (PP) and systolic BP (SBP) (all P < 0.05) than those with normal ACR. The closest univariate associations of Ao-PWV were positively with age, duration of diabetes, SBP, PP, ACR, and insulin treatment and negatively with GFR and weight (all P < 0.01). In a multiple linear step-down regression analysis, the significant predictors of Ao-PWV were age, SBP or PP, duration of diabetes, gender, number of antihypertensive medications, and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, which together explained 55% of the variance of Ao-PWV. When ACR was offered in place of arterial pressure to a separate model, ACR emerged as a significant predictor of Ao-PWV. After age adjustment, patients with lower, below median GFR had higher Ao-PWV than those with GFR above the median (P = 0.043). In patients with type 2 diabetes without overt renal impairment, raised ACR is associated with higher Ao-PWV, a relationship most likely mediated by raised BP. The association of Ao-PWV with reduced GFR suggests that even modest renal dysfunction may affect the viscoelastic properties of large arteries.
authors.affiliation: Unit for Metabolic Medicine, 5th Floor, Department of Diabetes and Endocrinology, Cardiovascular Division, GKT School of Medicine, King's College London, Guy's Hospital, St. Thomas Street, London SE1 9RT, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.forename: Janaka
authors.initials: J
authors.lastname: Karalliedde
authors.forename: Lorenita
authors.initials: L
authors.lastname: De Angelis
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Viberti
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D000419:Albuminuria / Q000209:etiology*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001011:Aorta / Q000503:physiopathology*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011674:Pulse; D012737:Sex Factors; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D003404:Creatinine