title: Ethnic disparity in central arterial stiffness and its determinants among Asians with type 2 diabetes.
abstract: OBJECTIVE
  We previously reported ethnic disparity in adverse outcomes among Asians with type 2 diabetes (T2DM) in Singapore. Central arterial stiffness can aggravate systemic vasculopathy by propagating elevated systolic and pulse pressures forward, thereby accentuating global vascular injury. We aim to study ethnic disparity in central arterial stiffness and its determinants in a multi-ethnic T2DM Asian cohort.
  
  
  METHODS
  Arterial stiffness was estimated by carotid-femoral pulse wave velocity (PWV) and augmentation index (AI) using applanation tonometry method in Chinese (N = 1045), Malays (N = 458) and Indians (N = 468). Linear regression model was used to evaluate predictors of PWV and AI.
  
  
  RESULTS
  PWV was higher in Malays (10.1 ± 3.0 m/s) than Chinese (9.7 ± 2.8 m/s) and Indians (9.6 ± 3.1 m/s) (P = 0.018). AI was higher in Indians (28.1 ± 10.8%) than Malays (25.9 ± 10.1%) and Chinese (26.1 ± 10.7%) (P < 0.001). Malays remain associated with higher PWV (β = 0.299, P = 0.048) post-adjustment for age, gender, duration of diabetes, hemoglobin A1c, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), soluble receptor for advanced glycation end-products, urinary albumin-to-creatinine ratio, and insulin usage, which were all independent predictors of PWV. Indians remain associated with higher AI (β = 2.776, P < 0.001) post-adjustment for age, gender, BMI, SBP, DBP, and height, which were independent predictors of AI. These variables explained 27.7% and 33.4% of the variance in PWV and AI respectively.
  
  
  CONCLUSIONS
  Malays and Indians with T2DM have higher central arterial stiffness, which may explain their higher risk for adverse outcomes. Modifying traditional major vascular risk factors may partially alleviate their excess cardiovascular risk through modulating arterial stiffness.
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Jian Jun
authors.initials: JJ
authors.lastname: Liu
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore; Department of Medicine, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Chee Fang
authors.initials: CF
authors.lastname: Sum
authors.affiliation: Department of Medicine, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Yeoh Lee
authors.initials: YL
authors.lastname: Ying
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore; Department of Medicine, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Subramaniam
authors.initials: S
authors.lastname: Tavintharan
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Xiao Wei
authors.initials: XW
authors.lastname: Ng
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
authors.forename: Serena
authors.initials: S
authors.lastname: Low
authors.affiliation: National Healthcare Group Polyclinics, Singapore 138543, Republic of Singapore.
authors.forename: Simon B M
authors.initials: SB
authors.lastname: Lee
authors.affiliation: National Healthcare Group Polyclinics, Singapore 138543, Republic of Singapore.
authors.forename: Wern Ee
authors.initials: WE
authors.lastname: Tang
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore; Department of Medicine, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore. Electronic address: lim.su.chi@alexandrahealth.com.sg.
authors.forename: Su Chi
authors.initials: SC
authors.lastname: Lim
mesh_terms: D000368:Aged; D001161:Arteriosclerosis / Q000208:ethnology* / Q000503:physiopathology; D044466:Asian People; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002681:China / Q000208:ethnology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D003925:Diabetic Angiopathies / Q000208:ethnology* / Q000503:physiopathology; D004198:Disease Susceptibility; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D017127:Glycation End Products, Advanced / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007194:India / Q000208:ethnology; D008296:Malaysia / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D063177:Pulse Wave Analysis; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D059289:Vascular Stiffness
chemical_list: D002317:Cardiovascular Agents; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D007004:Hypoglycemic Agents
keywords: Arterial stiffness; Augmentation index; Pulse wave velocity; Type 2 diabetes