Am J Cardiovasc Dis 2011;1(1):68-75

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).

Keywords: Diabetes mellitus, coronary artery disease, endothelial function, intima media thickness, microcirculation

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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
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