Characterization of macro-and microvascular function and structure in patients with type 2 diabetes mellitus

American Journal of Cardiovascular Disease

Tienush Rassaf¹  Yvonne Heinen¹  Malte Kelm¹  Thomas Lauer¹  Christian Heiss¹  Jan Balzer¹  Stefanie Keymel¹ 

关键词: Diabetes mellitus;    coronary artery disease;    endothelial function;    intima media thickness;    microcirculation;   

DOI  :  

学科分类：心脏病和心血管学

来源: e-Century Publishing Corporation

【 摘 要 】

Objective: Diabetes mellitus (DM) leads to accelerated progression of arteriosclerosis with an increased risk of coronary events in comparison to non-diabetic patients with coronary artery disease (CAD). The precise and early detection of DM-induced vascular alterations is crucial to identify patients with high risk for cardiovascular complications. Thus, we aimed at simultaneously characterizing functional, physicomechanical, and structural vascular alterations in diabetic patients using a non-invasive approach. Research Design and Methods: In CAD patients with and without type 2 diabetes mellitus (n=50), we non-invasively measured flow-mediated dilation (FMD) of the brachial artery as a marker for endothelial function, fractional diameter changes (FDC) as a marker for physicomechanical properties, intima-media thickness (IMT) as a marker for structural properties, and forearm blood flow (FBF) as a marker for microvascular function. Results: DM was associated with reduced FMD (2.5±0.2 vs 4.8±0.4%; p≤0.001) indicating impaired macrovascular endothelial function. In parallel, reduced FDC (0.024±0.002 vs 0.034±0.004; p≤0.05) and increased IMT (0.38±0.01 vs 0.31±0.01mm; p≤0.001) indicated increased stiffness and enhanced structural alterations. Furthermore, reduced forearm blood flow during reactive hyperemia (10.7±1.0 vs. 15.3±1.4mL/min*100mL; p≤0.05) was found indicating microvascular dysfunction. Plasma glucose and HbA_1c correlated with FMD (glucose: r=-0.32; HbA_1c: r=-0.45), IMT (glucose: r=0.54; HbA_1c: r=0.48) and FBF (glucose: r=-0.30) suggesting diabetes-specific effects on vascular properties. Conclusion: In patients with CAD, DM leads to functional and structural vascular alterations of the peripheral vasculature which are determined by the control of the disease underlining the relevance of a strict control of the DM to prevent accelerated atherosclerosis.

【 授权许可】

Unknown