title: Elevated plasma factor VIII and von Willebrand factor in women with type 2 diabetes:  inflammatory reaction, endothelial perturbation or else?
abstract: The association between type 2 diabetes and cardiovascular disease is long recognized. Although perturbations of haemostatic markers have been shown to be associated with macrovascular disease in patients with type 2 diabetes, it is unclear whether these are primarily due to endothelial dysfunction or a result of inflammation. The present study was undertaken to elucidate whether elevated levels of factor VIII (FVIII) and von Willebrand factor (vWF) in women with type 2 diabetes represent endothelial dysfunction, inflammation or an alternate mechanism. Sixty-four women with type 2 diabetes were evaluated using ultrasonography Doppler for carotid intima-media thickness (IMT) and were classified as group A--having no (<1  mm), group B - mild (≥1  mm and no plaque) and group C--moderate (≥1 mm and presence of plaque and stenosis) macrovascular disease. Several haemostatic markers including, FVIII, vWF and fibrinogen were assessed. In addition, thrombomodulin, a marker for endothelial damage, and high-sensitivity C-reactive protein (hsCRP), an inflammatory marker, were also measured. A significant association of elevated FVIII was found in group B and C patients (i.e. patients with IMT ≥1 mm and with plaque). Elevated fibrinogen and vWF levels were also found but confined to group C patients. No significant difference among subgroups was found for any other variable evaluated (hsCRP, thrombomodulin and FVII). In conclusion, plasma FVIII levels are elevated in women with type 2 diabetes and macrovascular disease. It also appears that this is not mediated by inflammation or endothelial injury and is likely to be due to an alternate mechanism.
authors.affiliation: Faculty of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Soares
authors.forename: Rashid S
authors.initials: RS
authors.lastname: Kazmi
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Borges
authors.forename: Pedro W
authors.initials: PW
authors.lastname: Rosário
authors.forename: Ana P
authors.initials: AP
authors.lastname: Fernandes
authors.forename: Marinez O
authors.initials: MO
authors.lastname: Sousa
authors.forename: Bashir A
authors.initials: BA
authors.lastname: Lwaleed
authors.forename: Maria G
authors.initials: MG
authors.lastname: Carvalho
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology; D005169:Factor VIII / Q000378:metabolism*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D018180:Thrombomodulin / Q000097:blood; D017539:Tunica Intima / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D018180:Thrombomodulin; D014841:von Willebrand Factor; D005169:Factor VIII; D005340:Fibrinogen; D002097:C-Reactive Protein