Aortic Pulse Wave Velocity and Albuminuria in Patients with Type 2 Diabetes

Abstract

Development of microalbuminuria increases the risk for cardiovascular disease (CVD) in type 2 diabetes. The nature of this relationship is unclear but may involve arterial stiffness, an independent risk marker for CVD mortality. Aortic pulse wave velocity (Ao-PWV) and albumin creatinine ratio (ACR) were measured in 134 consecutive patients with type 2 diabetes without overt renal impairment (serum creatinine <150 mol/L). ACR ranged from 0.2 to 153 mg/mmol. Patients with raised ACR (>3 mg/mmol) had higher Ao-PWV, poorer diabetic control, and higher pulse pressure (PP) and systolic BP (SBP) (all P < 0.05) than those with normal ACR. The closest univariate associations of Ao-PWV were positively with age, duration of diabetes, SBP, PP, ACR, and insulin treatment and negatively with GFR and weight (all P < 0.01). In a multiple linear step-down regression analysis, the significant predictors of Ao-PWV were age, SBP or PP, duration of diabetes, gender, number of antihypertensive medications, and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, which together explained 55% of the variance of Ao-PWV. When ACR was offered in place of arterial pressure to a separate model, ACR emerged as a significant predictor of Ao-PWV. After age adjustment, patients with lower, below median GFR had higher Ao-PWV than those with GFR above the median (P ‫؍‬ 0.043). In patients with type 2 diabetes without overt renal impairment, raised ACR is associated with higher Ao-PWV, a relationship most likely mediated by raised BP. The association of Ao-PWV with reduced GFR suggests that even modest renal dysfunction may affect the viscoelastic properties of large arteries.

Arterial Stiffness in Mild-to-Moderate CKD

“…Our findings concur with the similar associations noted in prior reports involving individuals with diabetes, 26,27 hypertension, 28 and the general population. 15,29 Our cross-sectional analysis, however, was unique for a large sample size, robust multivariable adjustment, and the use of gold standard tonometry measures for central arterial stiffness.…”

Central Hemodynamics and Target Organ Damage in Hypertension

“…In fact, a recent study has demonstrated that a higher aortic pulse pressure is independently associated with the presence of albuminuria in patients with hypertension (Hashimoto and Ito 2011). This study agrees well with previous studies showing significant associations of the aortic PWV and augmentation index with the urinary albumin excretion (Tsioufis et al 2003;Smith et al 2005). Moreover, the aortic pulse pressure has been shown to correlate with proteinuria and serum creatinine more closely than the peripheral (femoral) pulse pressure in patients with coronary risk (Temmar et al 2010).…”

Increases in Central Aortic Impedance Precede Alterations in Arterial Stiffness Measures in Type 1 Diabetes

“…In addition, our data suggest that once microalbuminuria develops, the relationship between arterial hemodynamics and renal vascular function may be altered, a concept supported by others (31). A similar relationship between pulse pressure or measures of central aortic stiffness and urine albumin excretion has been noted previously in type 2 diabetes (7,32,33), whereas urine albumin does not necessarily correlate with hyperinsulinemia (34), again suggesting the importance of hemodynamic changes in the development of renal microvascular disease. The link between pulse pressure or central arterial stiffness and urine albumin levels has also been demonstrated in patients with hypertension (16,(35)(36)(37)(38)(39)(40)(41) and in healthy adults (42,43).…”