Abstract 2769: Noninvasive Ultrasonic Evaluated Endothelial Dysfunction Highly Predicts Future Diabetic Evolution and Adverse Cardiovascular Events
Background: Although diabetes mellitus (DM) and endothelial dysfunction (ED) are thought to affect atherogenic processes, we know little about the clinical impact of ED on evolutional mechanisms of DM. This study assessed hypothesis that ED accelerates diabetic evolution (DME) and increases incidence of adverse cardiovascular events (CVE).
Methods: ED was noninvasively graded by reactive changes in lumen diameter of right brachial artery following transient forearm occlusion for 5 minutes (FMD; flow-mediated endothelium-dependent vasodilation) in consecutive 518 patients with stable coronary artery disease using high-resolutional ultrasonography. The enrolled patients were categorized into 3 groups according to the values of FMD, and their status of glucose tolerance and CVE were followed-up for no less than 36 months. We prospectively followed up DME, which was defined as newly diagnosed DM by 75g-OGTT or new administration of an antidiabetic agent.
Results: For a mean follow-up period of 60 months with complete follow-up, the patients with severe ED (FMD<4%; Group-L, n=174) far more frequently manifested DME and CVE [p<0.001, by Kaplan-Meier analyses] compared to those of Group-M with mild endothelial dysfunction (4%≤FMD<8%, n=171) and Group-H with preserved endothelial function (FMD 8% or more, n=173). HbA1c, as a diabetic marker, significantly elevated in patients of Group-L (p=0.009) but not in those of Group-M or Group-H. Cox proportional hazard model analyses including clinical variables showed that severe ED was a strong predictor for future DME (hazard ratio=2.69, p=0.011) and CVE (hazard ratio=3.75, p<0.001).
Conclusion: This is the first clinical ultrasonic vascular investigation demonstrating endothelial dysfunction accelerates diabetic evolution and causes excess of adverse cardiovascular events, and strategies based on practical status of endothelial dysfunction are required for both diabetic and cardiovascular managements.