title: Associations of atherosclerosis in the descending thoracic aorta on CTA with arterial stiffness and chronic kidney disease in asymptomatic patients with diabetes mellitus.
abstract: The relation between atherosclerosis in the descending thoracic aortic (DTA), arterial stiffness and chronic kidney disease (CKD) in patients with diabetes mellitus (DM) remains unclear. The current aim was to evaluate associations of DTA atherosclerosis with arterial stiffness and parameters of CKD in asymptomatic patients with DM. A total of 213 asymptomatic patients with diabetes (mean age 52 years, 56% men) underwent cardiovascular risk assessment including multi-slice computed tomography (for non-invasive coronary angiography, from which DTA atherosclerosis can be derived), non-invasive assessment of arterial stiffness with applanation tonometry and assessment of renal function. Measurements of DTA atherosclerosis included assessment of DTA thickening and calcium score. Arterial stiffness was determined by the carotid-femoral pulse wave velocity (PWV), parameters of CKD included estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR). DTA atherosclerosis was present in 180 (84%) patients. Patients with DTA atherosclerosis had increased arterial stiffness, lower eGFR and higher UACR values. After multivariate correction, DTA calcium score was independently associated with PWV (β = 0.18, p = 0.04). Furthermore, both DTA maximal wall thickness and DTA calcium score were independently associated with eGFR (β = -7.37, p < 0.001 and β = -1.99, p < 0.003, respectively), but not with UACR. The increase in arterial stiffness by atherosclerosis seemed to be mediated by arterial calcification, while the DTA calcium score was independently associated with arterial stiffness, but not DTA maximal wall thickness. Furthermore, parameters of CKD in patients with DM had a distinct relationship with DTA atherosclerosis: DTA atherosclerosis was associated with eGFR but not with UACR.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands, c.j.roos@lumc.nl.
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: Roos
authors.forename: V
authors.initials: V
authors.lastname: Delgado
authors.forename: Eelco J
authors.initials: EJ
authors.lastname: de Koning
authors.forename: Ton J
authors.initials: TJ
authors.lastname: Rabelink
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Scholte
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D001027:Aortography / Q000379:methods*; D058070:Asymptomatic Diseases; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D015415:Biomarkers / Q000652:urine; D016009:Chi-Square Distribution; D003404:Creatinine / Q000652:urine; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008365:Manometry; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D063177:Pulse Wave Analysis; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D059289:Vascular Stiffness
chemical_list: D015415:Biomarkers; D003404:Creatinine