Circulation. 2003;107:2089-2095
Published online before print April 14, 2003, doi: 10.1161/01.CIR.0000065222.34933.FC
Published online before print April 14, 2003, doi: 10.1161/01.CIR.0000065222.34933.FC
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(Circulation. 2003;107:2089.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Arterial Stiffness Increases With Deteriorating Glucose Tolerance Status
The Hoorn Study
From the Institute for Research in Extramural Medicine (R.M.A.H., P.J.K., A.M.W.S., J.M.D., G.N., R.J.H., L.M.B., C.D.A.S.); Institute for Cardiovascular Research (R.M.A.H., A.M.W.S., O.K., N.W., C.D.A.S.); and Departments of Epidemiology and Biostatistics (P.J.K.), Physiology (N.W.), Endocrinology (R.J.H.), and Internal Medicine (C.D.A.S.), VU University Medical Center, Amsterdam, the Netherlands.
Correspondence to Professor C.D.A. Stehouwer, MD, PhD; Department of Internal Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. E-mail cda.stehouwer{at}vumc.nl
Background— Type 2 diabetes (DM-2) and impaired glucose metabolism (IGM) are associated with an increased cardiovascular disease risk. In nondiabetic individuals, increased arterial stiffness is an important cause of cardiovascular disease. Associations between DM-2 and IGM and arterial stiffness have not been systematically investigated.
Methods and Results— In a population-based cohort (n=747; 278 with normal glucose metabolism, 168 with IGM, and 301 with DM-2; mean age, 68.5 years), arterial stiffness was ultrasonically estimated by distensibility and compliance of the carotid, femoral, and brachial arteries and by the carotid elastic modulus. After adjustment for age, sex, and mean arterial pressure, DM-2 was associated with increased carotid, femoral, and brachial stiffness, whereas IGM was associated only with increased femoral and brachial stiffness. Carotid but not femoral or brachial stiffness increased from IGM to DM-2. Standardized ßs (95% CI) for IGM and DM-2, compared with normal glucose metabolism, were -0.06 (-0.23 to 0.10) and -0.37 (-0.51 to -0.23) for carotid distensibility; -0.02 (-0.18 to 0.18) and -0.25 (-0.40 to -0.09) for carotid compliance; -0.05 (-0.23 to 0.13) and 0.25 (0.10 to 0.40) for carotid elastic modulus; -0.70 (-0.89 to -0.51) and -0.67 (-0.83 to -0.52) for femoral distensibility; and -0.62 (-0.80 to -0.44) and -0.79 (-0.94 to -0.63) for femoral compliance. The brachial artery followed a pattern similar to that of the femoral artery. Increases in stiffness indices were explained by decreases in distension, increases in pulse pressure, an increase in carotid intima-media thickness, and, for the femoral artery, a decrease in diameter. Hyperglycemia or hyperinsulinemia explained only 30% of the arterial changes associated with glucose tolerance. Adjustment for conventional cardiovascular risk factors did not affect these findings.
Conclusions— IGM and DM-2 are associated with increased arterial stiffness. An important part of the increased stiffness occurs before the onset of DM-2 and is explained neither by conventional cardiovascular risk factors nor by hyperglycemia or hyperinsulinemia.
Key Words: epidemiology • diabetes mellitus • glucose • remodeling • vasculature
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