Abstract 1089: Persistent Impairment of Endothelial Vasomotor Function Predicts Development of Diabetes Mellitus in Patients With Coronary Artery Disease
Endothelial vasomotor dysfunction is implicated in the development of type 2 diabetes mellitus (DM). However, it remains unclear whether endothelial dysfunction in systemic arteries precedes development of DM. Also, it remains undefined whether reversibility of endothelial dysfunction in response to risk-factor reduction predicts development of DM. Thus, this study examined whether endothelial vasomotor dysfunction provides prognostic information for development of DM in patients with coronary artery disease (CAD).
Methods: This study included 245 consecutive non-DM patients with newly diagnosed CAD who had an impairment of flow-mediated dilation of the brachial artery (FMD) at enrollment. All patients had individualized, optimized therapies including medications and recommended life style changes to reduce risk factors for CAD according to the AHA guidelines. Measurement of FMD (expressed as percent dilation from baseline brachial artery diameter) was performed at enrollment (1st test) and 6 months (2nd test) after initiation of therapies. After the 2nd test, all patients continued their same medications and were prospectively followed for 36 months or until they developed DM, defined by the ADA diagnostic criteria. Impairment of FMD was defined as <5.5% (mean minus 1 SD of FMD in 100 age- and sex-matched normal subjects).
Results: FMD was persistently impaired (<5.5%) in 127 (52%) patients at their 2nd test, whereas it improved (FMD ≥5.5%) in the remaining 118 (48%) patients. During the follow-up period, DM developed in 30 (24%) patients with persistently impaired FMD and in 12 (10%) patients with improved FMD (p<0.001). Multivariate logistic regression analysis showed that persistent impairment of FMD was a significant predictor for developing DM (OR: 3.6, 95%CI: 1.7–7.4, p<0.001) independently of CRP levels, systolic blood pressure, body mass index and use of anti-hypertension medications and β-blocker at 2nd test. In contrast, the 1st FMD before therapies to reduce risk factors had no significant predictive value for development of DM.
Conclusions: Persistent endothelial vasomotor dysfunction in the brachial artery despite optimized therapies to reduce CAD risk factors may be related to development of DM in CAD patients.