title: Carotid-femoral pulse wave velocity is associated with cerebral white matter lesions in type 2 diabetes.
abstract: OBJECTIVE
  Patients with type 2 diabetes have a high incidence of cardiovascular events including stroke. Increased arterial stiffness (AS) predicts cardiovascular events in the general population. Cerebral white matter lesions (WMLs) are associated with an increased risk of stroke. It is unknown whether AS in patients with type 2 diabetes is associated with WMLs.
  
  
  METHODS
  We examined 89 patients recently diagnosed with type 2 diabetes (<5 years) and 89 sex- and age-matched controls. AS was assessed with carotid-femoral pulse wave velocity (PWV). WMLs were identified using magnetic resonance imaging and graded qualitatively with the Breteler scale (no/slight changes = 0, moderate changes = 1, severe changes = 2) and semiquantitatively.
  
  
  RESULTS
  The diabetic population had excellent glycemic control (HbA(1c), 6.5% [6.2-6.8]; median [interquartile range {IQR}]) and had, compared with the controls, lower office blood pressure (BP) (127 ± 12/79 ± 8 vs. 132 ± 14/84 ± 10 mmHg) and total cholesterol (4.3[3.9-4.7] vs. 5.6 [5.1-6.4]; mmol/L; median [IQR]), (P < 0.01 for all). Despite this, PWV was higher in the patients with diabetes compared with controls (9.3 ± 2.0 vs. 8.0 ± 1.6 m/s; P < 0.0001). PWV was associated with Breteler score (OR 1.36 [95% CI 1.17-1.58]; P < 0.001) and WML volume (OR 1.32 [95% CI 1.16-1.51]; P < 0.001) per 1 m/s increase in PWV. These associations remained significant when adjusted for age, sex, diabetes, 24-h mean arterial BP, BMI, heart rate, and use of antihypertensives and statins (Breteler score: OR 1.28 [95% CI 1.03-1.60]; P < 0.05 and WML volume: OR 1.30 [95% CI 1.06-1.58]; P < 0.05).
  
  
  CONCLUSIONS
  PWV was higher among patients with well-controlled type 2 diabetes compared with controls and was independently associated with WMLs. PWV may represent a clinically relevant parameter in the evaluation of cerebrovascular disease risk in type 2 diabetes.
authors.affiliation: Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Noerrebrogade, Denmark. esben.laugesen@ki.au.dk
authors.forename: Esben
authors.initials: E
authors.lastname: Laugesen
authors.forename: Pernille
authors.initials: P
authors.lastname: Høyem
authors.forename: Brian
authors.initials: B
authors.lastname: Stausbøl-Grøn
authors.forename: Anders
authors.initials: A
authors.lastname: Mikkelsen
authors.forename: Samuel
authors.initials: S
authors.lastname: Thrysøe
authors.forename: Mogens
authors.initials: M
authors.lastname: Erlandsen
authors.forename: Jens S
authors.initials: JS
authors.lastname: Christiansen
authors.forename: Søren T
authors.initials: ST
authors.lastname: Knudsen
authors.forename: Klavs W
authors.initials: KW
authors.lastname: Hansen
authors.forename: Won Y
authors.initials: WY
authors.lastname: Kim
authors.forename: Troels K
authors.initials: TK
authors.lastname: Hansen
authors.forename: Per L
authors.initials: PL
authors.lastname: Poulsen
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D059289:Vascular Stiffness / Q000502:physiology