Original Article Characterization of macro- and microvascular function and structure in patients with type 2 diabetes mellitus
Stefanie Keymel, Yvonne Heinen, Jan Balzer, Tienush Rassaf, Malte Kelm, Thomas Lauer, Christian Heiss
University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Duesseldorf, Germany
Received April 9, 2011; accepted May 13, 2011; Epub May 15, 2011; published June 1, 2011
Abstract: 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 of 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 (FBF) 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 HbA1c correlated with FMD (glucose: r=-0.32; HbA1c: r=-0.45), IMT (glucose: r=0.54; HbA1c: 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.(AJCD1104002).
Address all correspondence to: Christian Heiss, MD University Duesseldorf Medical Faculty Department of Cardiology, Pulmonology, and Vascular Medicine Moorenstr. 5 40225 Duesseldorf Tel: +49-211-8118801 Fax: +49-211-8118812 e-mail: email@example.com