Determinants of vascular function in patients with type 2 diabetes.
BACKGROUND
Type 2 diabetes mellitus (T2DM) is independently associated with an increased risk for cardiovascular diseases that is primarily due to the early development of advanced atherosclerotic vascular changes. The aim of our study was to investigate the predictors of vascular dysfunction in T2DM patients.


METHODS
We studied 165 T2DM patients without known macrovascular or microvascular disease. Standard demographic (age, gender, cardiovascular risk factors, medications), clinical (body mass index, blood pressure) and laboratory (glucose, glycated hemoglobin, lipids, renal function) parameters were included in analyses. Brachial artery flow-mediated dilation (FMD), nitrate mediated dilation (NMD) and Carotid-Femoral Pulse Wave Velocity (PWV) were measured.


RESULTS
Median age was 66 years and duration since T2DM diagnosis was 10 years, 70% were females and 79% hypertensives, while only 10% had a glycated hemoglobin <7%. FMD was positively associated with NMD (r 0.391, P < 0.001), while PWV was inversely associated with FMD (r -0.218, P = 0.014) and NMD (r -0.309, P < 0.001). Time since diagnosis of diabetes was the single independent predictor of FMD (β -0.40, P = 0.003). Increased age and fasting glucose and the presence of hypertension were independent predictors of decreased NMD (P < 0.001). Increased age and systolic blood pressure were independently associated with increased PWV (P < 0.001).


CONCLUSIONS
In T2DM patients, impairment of endothelium-dependent vasodilation was independently associated only with longer diabetes duration while no association with other established risk factors was found. Vascular smooth muscle dysfunction and increased arterial stiffness were more prominent in older T2DM patients with hypertension. Worse glycemic control was associated with impaired vascular smooth muscle function.
Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece.
Katerina K
KK
Naka
Katerina
K
Papathanassiou
Aris
A
Bechlioulis
Nikolaos
N
Kazakos
Konstantinos
K
Pappas
Stelios
S
Tigas
Dimitrios
D
Makriyiannis
Agathocles
A
Tsatsoulis
Lampros K
LK
Michalis
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D002339:Carotid Arteries / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009131:Muscle, Smooth, Vascular / Q000503:physiopathology; D005996:Nitroglycerin / Q000008:administration & dosage; D011237:Predictive Value of Tests; D063177:Pulse Wave Analysis; D013997:Time Factors; D018608:Ultrasonography, Doppler; D059289:Vascular Stiffness; D014664:Vasodilation / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D005996:Nitroglycerin; D014665:Vasodilator Agents; C517652:hemoglobin A1c protein, human