title: Central pulse pressure and its hemodynamic determinants in middle-aged adults with impaired fasting glucose and diabetes: the Asklepios study.
abstract: OBJECTIVE
  Pulse pressure (PP), a strong predictor of cardiovascular events in type 2 diabetes, is a composite measure affected by several hemodynamic factors. Little is known about the hemodynamic determinants of central PP in type 2 diabetes or whether abnormalities in central pulsatile hemodynamics are already present in individuals with impaired fasting glucose (IFG). In a population-based study, we aimed to compare central PP and its hemodynamic determinants among adults with normal fasting glucose (n = 1654), IFG (n = 240), and type 2 diabetes (n = 33).
  
  
  METHODS
  We measured carotid pressure, left ventricular outflow, aortic root diameter, carotid artery flow, and distension in order to measure various structural and hemodynamic arterial parameters.
  
  
  RESULTS
  IFG was associated with a greater mean arterial pressure (MAP) but was not associated with intrinsic aortic stiffening or abnormal aortic pulsatile indices after adjustment for MAP. After adjustment for age, sex, and MAP, type 2 diabetes was associated with a higher aortic root characteristic impedance (Zc), aortic root elastance-thickness product (Eh), and aortic root pulse wave velocity (but not aortic root diameter), a greater carotid-femoral pulse wave velocity, and lower total arterial compliance and wave reflection magnitude. Carotid size, Zc, distensibility, or Eh did not significantly differ between the groups.
  
  
  CONCLUSIONS
  Type 2 diabetes, but not IFG, is associated with greater large artery stiffness, without abnormalities in aortic root diameter or carotid stiffness. Subjects with type 2 diabetes demonstrate a decreased reflection magnitude, which may indicate an increased penetration of pulsatile energy to distal vascular beds.
authors.affiliation: University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. julio.chirinos@uphs.upenn.edu
authors.forename: Julio A
authors.initials: JA
authors.lastname: Chirinos
authors.forename: Patrick
authors.initials: P
authors.lastname: Segers
authors.forename: Thierry C
authors.initials: TC
authors.lastname: Gillebert
authors.forename: Marc L
authors.initials: ML
authors.lastname: De Buyzere
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Van Daele
authors.forename: Zubair A
authors.initials: ZA
authors.lastname: Khan
authors.forename: Umair
authors.initials: U
authors.lastname: Khawar
authors.forename: Dirk
authors.initials: D
authors.lastname: De Bacquer
authors.forename: Ernst R
authors.initials: ER
authors.lastname: Rietzschel
mesh_terms: D000328:Adult; D001011:Aorta / Q000033:anatomy & histology; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005215:Fasting; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000503:physiopathology*; D059289:Vascular Stiffness
chemical_list: D001786:Blood Glucose