Arterial stiffening could predict CVD risk in Type 2 diabetes
MedWire News: Patients with Type 2 diabetes show stiffening of the large central arteries, a finding that is closely associated with diastolic dysfunction, report researchers who suggest that these disorders have a common etiology.
Type 2 diabetes is associated with an increased risk for both clinical and subclinical cardiovascular disease (CVD), study author Georgia Soldatos (Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia) and colleagues explain.
"While there is overwhelming evidence to support the use of lipid-lowering agents, angiotensin-converting enzyme inhibitors, and aspirin in secondary prevention, the real clinical challenge lies in the identification of at-risk individual subjects before the development of overt CVD," they comment in the journal Diabetic Medicine.
Arterial biomechanical properties have been associated with CV morbidity and mortality independently of conventional CV risk factors.
"Thus, it is postulated that assessment of these properties may have utility in risk prediction before the development of overt CVD in patients with Type 2 diabetes," the team comments.
To test the feasibility of this idea, the researchers assessed arterial biomechanical properties in 55 individuals with Type 2 diabetes and 66 age- and gender-matched healthy controls.
Measurements used were systemic arterial compliance (SAC; two-element Windkessel model), carotid-femoral pulse wave velocity (PWVc-f), femoral-dorsalis pedis pulse wave velocity (PWVf-d), and carotid augmentation index. Cardiac structure and function were assessed by echocardiography.
Soldatos et al report that individuals with Type 2 diabetes had lower SAC and higher PWVc-f compared with the healthy population.
Carotid augmentation index was similar in both groups, but the time to the first systolic inflection was shorter in patients with Type 2 diabetes.
Type 2 diabetes patients also had a greater prevalence of diastolic abnormalities when compared with the control group.
Arterial stiffness indices, including SAC, PWVc-f, and pulse pressure, correlated with left ventricular filling pressure (defined as peak velocity during early diastolic filling divided by the velocity of movement of the mitral valve annulus in early diastole).
Soldatos and team speculate that there may be a causative mechanism linking these parameters.
"For example, large artery stiffening may be the incipient event, resulting in impaired ventriculo-vascular coupling and diastolic dysfunction," they comment.
"Careful longitudinal studies will be required to resolve these possibilities."
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By Andrew Czyzewski