Diabetic state as a crucial factor for impaired arterial elastic properties in patients with peripheral arterial disease.
BACKGROUND
Increased arterial stiffness is associated with greater risk of cardiovascular events and mortality. However, in patients with peripheral arterial disease (PAD) who have severe atherosclerotic disorder or risk clustering, the major determinants of increased stiffness have been not clarified.


METHODS
This study investigated the associations between elastic properties of the carotid artery as measured by ultrasonography and atherosclerotic risk factors, with particular focus on diabetes mellitus (DM), in PAD patients (n=481; mean age, 69.6 years). DM was defined as hemoglobin A1c >/=6.5%, administration of anti-diabetic agents, or DM pattern on 75-g oral glucose tolerance test. Stiffness beta index was calculated from luminal diameter changes measured by the M-mode method using a linear array imaging probe.


RESULTS
Stiffness parameter beta was significantly increased in diabetic patients compared with non-diabetic patients (9.56+/-0.35 vs. 8.31+/-0.32; p=0.009) in an age- and gender-adjusted model. This significant difference was maintained in a multivariate-adjusted model including age, gender, hypertension, hyperlipidemia, obesity and smoking history (9.43+/-0.36 vs. 8.39+/-0.33; p=0.037). No significant differences in mean intima-media complex thickness or plaque score of the carotid artery were seen between diabetic and non-diabetic patients.


CONCLUSIONS
Diabetic condition impairs the elastic properties of arteries, independent of other known atherosclerotic risk factors or excessive intimal diseases in PAD patients. This may support the notion that diabetic condition can worsen prognosis for PAD patients.
Makita
Shinji
S
Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, 19-1 Uchimaru, Morioka, Japan. makitas@seagreen.ocn.ne.jp
Matsui
Hiroki
H
Naganuma
Yujirou
Y
Abiko
Akihiko
A
Tamada
Makiko
M
Nakamura
Motoyuki
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000503:physiopathology*; D004548:Elasticity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014463:Ultrasonography