title: Comparison of skin microvascular reactivity with hemostatic markers of endothelial dysfunction and damage in type 2 diabetes.
abstract: OBJECTIVE
  Patients with non-insulin-dependent diabetes mellitus (NIDDM) are at increased cardiovascular risk due to an accelerated atherosclerotic process. The present study aimed to compare skin microvascular function, pulse wave velocity (PWV), and a variety of hemostatic markers of endothelium injury [von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA), tissue factor pathway inhibitor (TFPI), and the soluble form of thrombomodulin (s-TM)] in patients with NIDDM.
  
  
  METHODS
  54 patients with NIDDM and 38 sex- and age-matched controls were studied. 27 diabetics had no overt micro- and/or macrovascular complications, while the remainder had either or both. The forearm skin blood flow was assessed by laser-Doppler imaging, which allowed the measurement of the response to iontophoretically applied acetylcholine (endothelium-dependent vasodilation) and sodium nitroprusside (endothelium-independent vasodilation), as well as the reactive hyperemia triggered by the transient occlusion of the circulation.
  
  
  RESULTS
  Both endothelial and non-endothelial reactivity were significantly blunted in diabetics, regardless of the presence or the absence of vascular complications. Plasma vWF, TFPI and s-TM levels were significantly increased compared with controls only in patients exhibiting vascular complications. Concentrations of t-PA and PAI-1 were significantly increased in the two groups of diabetics versus controls.
  
  
  CONCLUSIONS
  In NIDDM, both endothelium-dependent and -independent microvascular skin reactivity are impaired, whether or not underlying vascular complications exist. It also appears that microvascular endothelial dysfunction is not necessarily associated in NIDDM with increased circulating levels of hemostatic markers of endothelial damage known to reflect a hypercoagulable state.
authors.affiliation: Division de Physiopathologie Clinique, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland.
authors.forename: Sandra
authors.initials: S
authors.lastname: Beer
authors.forename: François
authors.initials: F
authors.lastname: Feihl
authors.forename: Juan
authors.initials: J
authors.lastname: Ruiz
authors.forename: Irène
authors.initials: I
authors.lastname: Juhan-Vague
authors.forename: Marie-Françoise
authors.initials: MF
authors.lastname: Aillaud
authors.forename: Sandrine Golay
authors.initials: SG
authors.lastname: Wetzel
authors.forename: Lucas
authors.initials: L
authors.lastname: Liaudet
authors.forename: Rolf C
authors.initials: RC
authors.lastname: Gaillard
authors.forename: Bernard
authors.initials: B
authors.lastname: Waeber