title: Endothelial dysfunction in type 2 diabetic patients with normal coronary arteries: a digital reactive hyperemia study.
abstract: BACKGROUND
  To assess endothelial function (EF) in type 2 diabetic patients with angiographically normal coronaries compared to diabetic patients with obstructive coronary artery disease (CAD) and to non-diabetic patients, with and without CAD.
  
  
  METHODS
  One hundred eighty-three patients undergoing coronary angiography were divided in: group 1 with diabetes mellitus (DM) and CAD (n = 58); group 2 with DM without CAD (n = 58); group 3 with CAD without DM (n = 31) and group 4 without CAD and DM (n = 36). EF was assessed by reactive hyperemia index (RHI) using a fingertip peripheral arterial tonometry and compared to values obtained in 20 healthy volunteers.
  
  
  RESULTS
  RHI was significantly lower in patients with DM compared to patients without DM (1.69 ± 0.38 vs 1.84 ± 0.44; p = 0.019). RHI was comparable among groups 1, 2 and 3, each value being significantly lower compared to group 4 (2 ± 0.44; p<0.001 vs group 1; p<0.005 vs group 2; p<0.002 vs group 3). At multivariate analysis DM and CAD were significant predictors of endothelial dysfunction (ED) (OR = 2.29; p = 0.012; OR = 2.76; p = 0.001, respectively), whereas diabetic patients (n = 116) CAD and glycated haemoglobin (HbA1c) were independent significant predictors of ED (OR = 3.05; p = 0.009; OR = 1.96; p = 0.004, respectively). Diabetic patients with ED (n = 67) had higher levels of HbA1c than diabetic patients with normal endothelial function (7.35 ± 0.97 vs 6.87 ± 0.90; p = 0.008) and RHI inversely correlated to HbA1c (p = 0.02; r = -0.210).
  
  
  CONCLUSIONS
  Diabetic patients with and without CAD show significantly impaired peripheral vascular function compared to non-diabetic patients without CAD. ED in diabetic patients without CAD is comparable to that of patients with CAD but without DM. HbA1c is a weak independent predictor of ED.
authors.affiliation: Department of Internal Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Gargiulo
authors.forename: Caterina
authors.initials: C
authors.lastname: Marciano
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Savarese
authors.forename: Carmen
authors.initials: C
authors.lastname: D'Amore
authors.forename: Stefania
authors.initials: S
authors.lastname: Paolillo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Esposito
authors.forename: Maurizio
authors.initials: M
authors.lastname: Santomauro
authors.forename: Fabio
authors.initials: F
authors.lastname: Marsico
authors.forename: Donatella
authors.initials: D
authors.lastname: Ruggiero
authors.forename: Oriana
authors.initials: O
authors.lastname: Scala
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzano
authors.forename: Milena
authors.initials: M
authors.lastname: Cecere
authors.forename: Laura
authors.initials: L
authors.lastname: Casaretti
authors.forename: Pasquale
authors.initials: P
authors.lastname: Perrone Filardi
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology*; D003331:Coronary Vessels / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010991:Plethysmography / Q000379:methods; D011446:Prospective Studies