Aortic pulse wave velocity and albuminuria in patients with type 2 diabetes.
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.
Smith
Andrew
A
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.
Karalliedde
Janaka
J
De Angelis
Lorenita
L
Goldsmith
David
D
Viberti
Giancarlo
G
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
D000959:Antihypertensive Agents; D003404:Creatinine