title: Pulse wave reflection is associated with diabetes duration, albuminuria and cardiovascular disease in type 1 diabetes.
abstract: OBJECTIVE
  We investigate associations between the pulse-wave-derived measures augmentation pressure (AP) and augmentation index, and diabetic complications in type 1 diabetes.
  
  
  METHODS
  This cross-sectional study from 2009-2011 included 676 type 1 diabetes patients. SphygmoCor (Atcor Medical, Australia) measured AP and heart rate-adjusted augmentation index (AI75). Diabetic complications were micro- or macroalbuminuria [urinary albumin excretion rate (UAER) 30-299 or ≥300 mg/24-h], cardiovascular disease (CVD) (previous revascularization, myocardial infarction, peripheral arterial disease or stroke), autonomic dysfunction (heart rate variability <11 beats/min), or retinopathy (simple, proliferative or blindness). Adjustments included age, gender, diabetes duration, mean arterial pressure, heart rate, height, UAER, eGFR, HbA1c, total cholesterol, total daily insulin dose, antihypertensive medication, and smoking.
  
  
  RESULTS
  AP and AI75 measurements were available in 636 (94.1 %) patients and were 9.9 ± 7.6 mmHg and 16.9 ± 12.0, respectively. After adjustment, AP and AI75 were independently associated with diabetes duration and albuminuria (p ≤ 0.001). Furthermore, higher AP and AI75 were associated with previous CVD [adjusted odds ratios (95 % confidence interval) (per 1 SD increase) 1.9 (1.3-2.7) and 1.5 (1.0-2.2) (p ≤ 0.039)], but not with autonomic dysfunction or retinopathy (p ≥ 0.12).
  
  
  CONCLUSIONS
  In type 1 diabetes, augmentation pressure and heart rate-adjusted augmentation index were associated with diabetes duration, albuminuria, and CVD, independently of conventional risk factors. ClinicalTrials.gov:NCT01171248.
authors.affiliation: Steno Diabetes Center, Niels Steensens Vej 1, 2820, Gentofte, Denmark, ktld@steno.dk.
authors.forename: Simone
authors.initials: S
authors.lastname: Theilade
authors.forename: Maria
authors.initials: M
authors.lastname: Lajer
authors.forename: Tine Willum
authors.initials: TW
authors.lastname: Hansen
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications* / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000150:complications* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000473:pathology / Q000503:physiopathology* / Q000652:urine; D003928:Diabetic Nephropathies / Q000150:complications / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D013997:Time Factors; D059289:Vascular Stiffness / Q000502:physiology